The Effect of Tidal Model-Based Psychiatric Nursing Approach on Mothers of Children With Autism Spectrum Disorder

Study Overview
=================
Brief Summary
-----------------
The goal of this clinical trial is to examine the effect of Tidal Model-based psychiatric nursing approach on internalized stigma and psychological well-being in mothers of children diagnosed with ASD. The main question[s] it aims to answer are: [Is the Tidal Model-based psychiatric nursing approach effective on the internalized stigma of mothers with children diagnosed with ASD?] [Is the Tidal Model-based psychiatric nursing approach effective on the psychological well-being of mothers with children diagnosed with ASD?] Data will be collected through scale forms and face-to-face individual interviews. Within the scope of the pre-test application, data will be collected from all mothers in the sample group using the Personal Information Form, Parents' Internalized Stigma in Mental Illness Scale and Psychological Well-Being Scale. Face-to-face individual interviews will be conducted with each individual in the intervention group in line with the Tidal Model-based psychiatric nursing approach. The researchers will compare the experimental group and the control group to see whether the Tidal Model-based psychiatric nursing approach applied to mothers with children diagnosed with ASD has an effect on internalized stigma and psychological well-being.

Detailed Description
-----------------
Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder characterized by obsessive and repetitive behavior patterns and inadequacies in social interaction and communication, with symptoms usually appearing before the age of three in early development. It has been reported that the global prevalence of ASD has increased in recent years, and an estimated one in 100 children worldwide is diagnosed with ASD. After the diagnosis of autism, parents experience a difficult and stressful process and face various problems. In the current literature, parents of children diagnosed with ASD experience higher levels of stress, depression and anxiety compared to parents of children with normal development, and have lower levels of family adjustment, marital satisfaction and psychological well-being, they are more likely to divorce and have a lower quality of life. In addition, studies have shown that the parents of children diagnosed with ASD have financial difficulties, they feel feelings such as helplessness, inadequacy, and rejection, they are worried about their children's future and safety, and they are in terms of physical injuries during anger tantrums. It is reported that they are at risk and have difficulties in accessing services for their children. Another important difficulty experienced by parents is that they have to isolate themselves from society due to negative reactions from the environment regarding social acceptance and social support. Studies have shown that parents of children with autism are exposed to stigma. Parents state that they are held responsible for their children's situation and behaviors, they are judged and criticized for thinking that they are inadequate in controlling and disciplining their children, and therefore they feel shame, and they are exposed to reactive-harassing words and gazes in public spaces. In parallel, parents state that socialization is difficult due to their children's compulsive behaviors and difficulties in social interactions and emphasize that they experience social isolation. As a matter of fact, in a study, mothers who have children with ASD state that most people condemn the child's behavior and attribute the reason for these behaviors to parents being bad parents, and therefore they do not go out of the house with their children and they feel socially isolated. In addition, it has been reported that stigma has negative effects on parents' mental health and care experience, and social stigma is associated with depression, anxiety, and caregiving burden. Parents of children diagnosed with ASD as a result of social stigma may be affected by stigmatizing thoughts and attitudes towards them and internalize this stigmatization. Internalized stigma can be defined as the adoption of the stigmatizing views and attitudes of the society by the individual. Internalization of stigma; It causes a decrease in self-esteem, deterioration in social cohesion, the formation of feelings of inadequacy, guilt and shame, and self-isolation and avoidance behavior. In the literature, it is stated that internalized stigmatization is common in caregivers of children diagnosed with ASD. In a study conducted with 230 parents with children with autism, it was reported that 192 (83.5%) of the parents internalized stigma. In another study conducted with mothers of children diagnosed with ASD, the level of internalized stigma of mothers was found to be moderate. In addition, studies conducted with parents of children with autism indicate that internalized stigma has negative effects on the psychological health of parents. In a study conducted by Öz et al. (2020) with mothers of children diagnosed with ASD, a positive relationship was found between the perception of internalized stigma and symptoms of depression and anxiety, and it was determined that quality of life decreased as the perception of internalization increased. Wong et al. (2016) found a positive relationship between internalized stigma and psychological distress in their study with parents of children diagnosed with ASD. In another study conducted with caregivers of children with ASD, intellectual disability and physical disability, higher levels of internalized stigma were associated with lower subjective well-being in caregivers of children with ASD when compared to caregivers of children with mental and physical disabilities. has been demonstrated. In addition, another study reported that internalized stigmatization negatively affects psychological well-being of parents. As can be seen, taking care of a child with a neurodevelopmental disorder such as ASD can be a burden for parents and parents may have to face many difficulties while managing the care process. The psychological difficulties experienced can negatively affect the psychological well-being of parents. Psychological well-being is expressed as the pursuit of meaningful goals, the development and maintenance of positive relationships with others, self-realization, personal development and efforts to find meaning in life when faced with existential difficulties. The psychological well-being of the parents of children with autism is effective in reducing the burden of care, increasing the skills of caregivers, improving the quality of life, developing healthy coping methods, maintaining a functional family structure and optimizing the care of the child. Therefore, considering the impact of parental mental health on the care and family functioning of the child with autism, it becomes extremely important to empower parents, protect and improve mental health. As a result, it is essential that mental health professionals provide holistic and comprehensive care to the parents of the child diagnosed with ASD in a multidisciplinary approach, support them in coping with the problems they experience, and engage in activities to maintain a functional family structure. When the literature is examined, it is seen that the primary caregivers of children with ASD are mostly mothers, mothers are more interested in the care of their children and spend time compared to fathers . Studies have also shown that mothers of children with ASD experience higher levels of parenting stress, psychological distress, depression and anxiety, and have a lower quality of life compared to fathers. In this context, considering the possibility of mothers to be affected more psychologically and the traditional family structure in Turkey, psychiatric nurses, who are an important member of the mental health team, intervene to strengthen the mothers of children with ASD and to maintain their psychological well-being, both in individual and community mental health. of importance to. Considering the possible negative effects of internalized stigma on maternal mental health and the negative consequences of psychosocial problems on psychological well-being, it is extremely important that psychiatric nurses engage in intervention studies that address internalized stigma and psychological well-being. When the literature is examined, no intervention study has been found that examines two cases based on the nursing model for mothers of children diagnosed with ASD. For this reason, in this study, a psychiatric nursing approach based on the Tidal Model, which accepts that each individual is a unique individual, offers individual care and is a recovery-oriented approach will be applied. In the model, life is likened to a journey and it is stated that the individual may encounter various crises in this life journey, and the focus of care is to provide the support that the individual will need to help them continue their life journey in the fight against these crises. In addition, the concept of empowerment is at the center of the care process in the model, emphasizing the importance of the individual discovering his/her personal story, solving problems, revealing and using personal resources. In this context, it is appropriate to apply the Tidal Model-based psychiatric nursing approach to this sample group, considering that each mother's experience is unique as each child diagnosed with ASD is unique, the psychosocial problems experienced by the mothers, and the mothers' need for psychosocial support, empowerment and protection of mental health. is thought to be. In addition, internalized stigma negatively affects psychological well-being, while psychological well-being is a multidimensional concept that includes dimensions such as personal development, self-acceptance, life purpose, positive relationships with others, environmental dominance, and autonomy and the Tidal Model supports personal development. It is predicted that this model-based psychiatric nursing approach will contribute positively to the improvement of the mental health status of mothers, as it emphasizes the value of making sense of one's own life story and experiences, and reveals the importance of the individual's use of existing resources and problem-solving capacity.

Official Title
-----------------
The Effect of Tidal Model-Based Psychiatric Nursing Approach Applied on Mothers of Children With Autism Spectrum Disorder of Internalized Stigma and Psychological Well-being

Conditions
-----------------
Autism Spectrum Disorder

Intervention / Treatment
-----------------
* Other: Tidal Model-based psychiatric nursing approach


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Having a child diagnosed with ASD who is studying at Karaköprü Special Education and Practice School in Şanlıurfa. Those who agree to participate in the research No previous diagnosis of mental illness 18 years of age or older The mother who does not have problems in terms of hearing, speaking and understanding that will prevent communication in the interviews. Exclusion Criteria: Under 18 years of age Those who have problems in hearing, speaking and understanding that will prevent communication in the interviews Mother with any previous diagnosis of mental illness

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized Controlled Study
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental<br>Personal Information Form, Parents' Internalized Stigma in Mental Illnesses Scale and Psychological Well-Being Scale will be applied to the intervention group as part of the pre-test application. In order to provide individualized care in the research, face-to-face individual interviews will be conducted with each individual in the intervention group in line with the Tidal Model-based psychiatric nursing approach. The interview plan prepared in line with the Tidal Model-based psychiatric nursing approach to be applied to the mothers in the intervention group in the study consists of eight interviews. The average of the first and eighth interviews is 45-50 minutes; Other interviews are expected to last an average of 70-75 minutes. | Other: Tidal Model-based psychiatric nursing approach<br>* 8 meetings in 2 month<br>|
| No Intervention: Control<br>The mothers who met the inclusion criteria and agreed to participate in the study were informed about the research such as the subject, purpose and content of the research, their verbal and written consents were obtained, and the Personal Information Form, Parents' Internalized Stigma in Mental Illness Scale and '' An interview will be held with the aim of applying the Psychological Well-Being Scale pre-tests. A second interview will be held with the aim of applying the post-tests and conducting the interview on Self-Perception with the intervention group to the control group. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Parents Internalized Stigma of Mental Illness Scale (PISMI) | The Internalized Stigma of Mental Illnesses Scale (ISMI) was developed by Boyd-Ritsher et al. (2003), and adapted into Turkish by Ersoy and Varan (2007). Then, by Dikeç et al. (2019) based on ISMI, the scale items were adapted to the parents of individuals with mental illness, and Turkish validity reliability was established. The scale consists of 29 items. The scale includes alienation (item: 1,5,8,16,17,21), confirmation of stereotypes (item: 26,10,18,19,23,29), perceived discrimination (item: 3.15). ,22,25,28), social withdrawal (item: 4,9,11,12,13,20), resistance to stigma (item: 7,14,24,26,27) It has five subscales. The items in the scale are answered as strongly disagree (1 point), disagree (2 points), agree (3 points), strongly agree (4 points). The scale total score ranges from 29 to 116 and there is no scale cutoff score. A high score from the scale indicates that the internalized stigma of the person is more severe in the negative direction. | Basseline and 4 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Psychological Well-Being Scale (PWS) | The scale was developed by Diener et al. (2009-2010) and adapted into Turkish by Telef (2013). The scale, which consists of eight items in total, has a seven-point Likert structure (1=Strongly disagree, 2=Disagree, 3=Somewhat disagree, 4=Undecided, 5=Disagree a little, 6=Agree, 7=Strongly agree). All items in the scale are expressed positively and the scale has no sub-dimensions. The lowest score obtained from the scale is 8, and the highest score is 56. The total score obtained from the scale is determined by adding the values given to all the items in the scale. A high score from the scale indicates that the person has a high level of psychological well-being. | Basseline and 4 weeks | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
internalized stigma, autism spectrum disorder, Tidal Model, psychological well-being