Resiliency Experiences of Family Members Who Take Care of

Patients with Schizophrenia

Rizki Fitryasari

, Ah. Yusuf

, Nursalam

, Rr. Dian Tristiana

and Rachmat Hargono

Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia

Keywords: Family Resilience, Family Members, Schizophrenic Patients.

Abstract: While caring for schizophrenic patients, families experience stressful situations. They need resilience skills,

the ability to survive, rise above, and become better at managing perceived stress. This study aimed to

describe family resilience from family members’ perspective. The research used qualitative design with a

phenomenology approach. The subjects were 15 family members who were primary caregivers of

schizophrenic patients treated at Menur Mental Hospital, Surabaya; a purposive sampling technique was

utilized. Data were collected by in-depth interviews and field notes and then analyzed using thematic

analysis based on Collaizi. The results showed that families achieve resiliency through five stages: surviving

their existing situation, changing family structure, trying to accept the family member, looking for positive

meaning, and providing support to others in the family. The families’ ability to find positive meaning is the

turning point for families when building resiliency. Families become rational, have self-confidence, rise

from stressful situations, and develop positive behaviors. Health workers, especially nurses, may review the

stages of family resilience to develop appropriate intervention for improving family resilience. Subsequent

research, focused on a family-based resilience model of nursing, is important to improve the treatment of

patients with schizophrenia.

1 BACKGROUND

The presence of schizophrenic patients in a family is

a source of stress and affects the family’s systems.

The inability to survive and deal with stress due to

various issues causes problems when treating

patients with schizophrenia at home, causing them to

relapse. Based on a preliminary study of 100

families at the Menur Mental Health Hospital

outpatient unit, Surabaya, from February 2017 to

April 2017, it was found that 65% of families felt

moderate stress and 16% experienced severe stress.

Families experienced stress and 67.8% perceived a

variety of expenses both subjectively and objectively

(Darwin et al., 2013).

Perceived burdens include subjective burdens

such as feeling worried about the condition of the

patient regarding health status, future, financial

condition, and fulfilling daily needs (Djatmiko,

2007; Ennis & Bunting, 2013; Hadryś et al., 2011).

Objective burdens are experienced through

situations such as declining caregiver health status,

decreasing interpersonal relationships, and

experiencing instability of marital relationships

(Chou et al., 2011; Fitrikasari et al., 2012).

Families who treat patients with schizophrenia

experience stigma: a negative view of society and

the environment. Families try to cover up the

existence of patients and isolate themselves from

community activities. Stigma is caused by limited

understanding within society regarding mental

disorders, influenced by tradition, deep-rooted

culture, and local beliefs (Syaharia, 2008). Because

of the stigma attached to patients and their families,

37.5% of families still have a negative perception of

the illness suffered by patients with schizophrenia.

Stigma is also experienced when feeling pity

towards a patient, alongside feeling insecure, alert,

and afraid of the existence of patients. Therefore,

there is a tendency to avoid patients and their

families (Ariananda, 2015). Stigma also causes

burdens, affecting the support from family and

society in the healing process of people with

schizophrenia (Wiharjo, 2014).

Schizophrenia is a considerable burden,

accounting for 8.1% of the global burden of disease

Fitryasari, R., Yusuf, A., Tristiana, R. and Hargono, R.

Resiliency Experiences of Family Members Who Take Care of Patients with Schizophrenia.

DOI: 10.5220/0008319600050013

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 5-13

ISBN: 978-989-758-336-0

(World Health Organization, 2008). The family, as

the primary caregiver, is susceptible to psychological

problems and 76.7% of families exhibit negative

symptoms and depression and influence the family’s

behavior when treating patients at home. The family

often induces irritation, due to its inability to cope

with the burden, by blaming the patient and

disregarding the patient's condition (Brillianita &

Munawir, 2014; Metkono et al., 2014).

The magnitude of the burden, the stigma both

from family and society, and the lack of support for

the family is a cause of family stress during caring

for patients with schizophrenia. Family members

need to be able to manage their stress situation,

survive, and rise from their difficulties. Stress

experienced by the family can be mediated by

resilience (Lee et al., 2011; Sun et al., 2012).

Family resilience is the process of adapting and

coping in the family as a functional unit. Resilience

involves a dynamic process between risk factors and

protective factors, which help people to adapt to

significant problems. Family resilience is a

combination of positive behavioral patterns and

functional competencies belonging to each

individual in the family and family unit as a whole

(Dehaan et al., 2013). Positive attitudes and

individual competencies are needed when reacting to

a stressful and detrimental environment (such as

addressing problems during the treatment of

schizophrenic patients). It also determines the ability

of the family to recover by maintaining its integrity

but by improving the welfare of family members and

family units.

Walsh (2016), in line with Dehaan (2013),

explains that resilience refers to the family process

as a functional unit, overcoming and adapting to

difficult circumstances. Family resilience is not just

the ability to survive in difficult situations, but also

overcoming difficulty in developing themselves and

connecting with others. Walsh explains that

resilience can be grown using three key family

resilience processes: belief systems, organizational

patterns, and communication. Each key to the

resilience process explains the strength of a family’s

potential to cultivate family resilience.

The belief system is the first key process and is

the core of family functioning that provides a strong

power for resilience (Walsh, 2016). The belief

system includes three areas that give meaning to

difficulties: positive views, transcendence, and

spirituality. The second key process is the pattern of

family organization that is shaped based on external

and internal norms and is influenced by the culture

and belief systems of the family. Elements of

organizational patterns include flexibility,

connectedness, and a family’s social economic

resources. The third key process is communication

within the family as a functioning component in

facilitating the realization of resilience (Walsh,

2016). Communication can support the problem-

solving process while the family is in a crisis.

Communication aspects include clarity, emotional

expression, and collaborative problem-solving.

Families need help from health professionals,

such as a psychiatric nurse, to use family power to

achieve resilience. Some studies already discuss the

family resilience process and indicators but has not

yet classified the stages of family resilience (Amagai

et al., 2016; Deist & Freeff, 2015; Faqurudheen et

al., 2014; Walsh, 2016). Our research expects to

complement the pre-existing theory by Walsh, who

believes that resilience involves three key family

strength processes. Families can use three family

strengths to balance the risk factor with the

protective factor. So, the family reaches a balance,

wakes up from a family crisis, and can deal with

problems. The family regains function and develops

more power to grow into a resilient family. This

study aims to describe family members’ experiences

in relation to resiliency, while taking care of

schizophrenic patients using qualitative research

with a phenomenological approach. Understanding

the steps of family resiliency will support psychiatric

nurses in helping families to quickly achieve family

resilience.

2 METHODS

2.1 Research Design

This qualitative research was based on the

phenomenological approach. The qualitative

research design was used to answer the research

objective related to family resilience, experienced by

family members taking care of patients with

schizophrenia. This study has obtained ethical

approval from the Ethical Committee of Menur

Health Mental Hospital with the reference number

423.4/72/305/2017.

2.2 Participant and Recruitment

The participants were family members who cared for

patients with schizophrenia, at the outpatients unit of

Menur Mental Health Hospital Surabaya, Indonesia.

The study involved 15 families as participants

obtained by purposive sampling techniques. The

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

inclusion criteria were as follows: family members

as primary caregivers of patients, more than 20 years

old, living in one house with a patient, and caring

the patients for at least one year. The patient should

also have been diagnosed with schizophrenia at least

three years before, proven by medical records, and

already experienced at least one recurrence.

Participants involved in the research previously

received a written explanation regarding the purpose

of the research, procedures, rights, obligations,

benefits, and disadvantages of the study. Only

participants who gave informed consent were

involved in the study. This study obtained ethical

approval from the Ethical Committee of Menur

Mental Health Hospital with the reference number

423.4/72/305/2017.

2.3 Data Collection and Analysis

The data collection process was carried out using in-

depth interviews, which were guided by a semi-

structured interview instrument and completed with

field notes. Interviews took between 44 and 60

minutes to conduct for each participant. Participants

were asked the question: "What steps are taken by

the family to overcome various difficulties during

the care of patients with schizophrenia?” Questions

were open-ended and interviews were recorded by a

voice recorder. The interview data and field notes

were written in verbatim and then analyzed and

interpreted using thematic analysis according to

Collaizi (1978), cited in Yusuf et al. (2017). They are

comprised of nine steps: 1) describing the

phenomena to be studied; 2) collecting descriptions

of the phenomena through participants' opinions; 3)

reading transcripts of the phenomena submitted by

participants; 4) outlining meaningful statements; 6)

organizing collections of meanings formulated into

groups of themes; 7) writing complete descriptions;

8) meeting participants to validate the compiled

descriptions; and 9) incorporating valid data results

into full descriptions. Demographic data were

calculated in relation to the number and percentage

to be presented in the form of a frequency table.

Two researchers conducted the interviews and

analytical process, i.e., R.F. and R.D.T. Both

researchers were experienced in conducting in-depth

interviews and had undertaken qualitative research

before. The two researchers met regularly to compile

the analysis results with the supervision of three

other researchers, N, A.Y., and R.H.

3 RESULT

3.1 Demographic Data

The demographic data of participants are shown in

Tables 1 and 2. This study followed 15 family

members as the primary caregivers of schizophrenic

patients (10 females and 5 males), aged between 26

and 58 years. The participants’ educational level

varied from non-schooled to university. Most of

them (10 people) work, as civil servants, privately,

or are self-employed, and five people were

unemployed. Most participants were parents (seven

mothers and two fathers), two spouses, one child,

two siblings and one sister-in-law. Family members

suffering from schizophrenia (six female and nine

male) were aged between 20 and 60 years. Most

schizophrenic patients did not work; only two people

worked at home as a tailor and a painter. Most of

them (12 people) regularly attended health services

and took regular medication. All patients

experienced a recurrence more than three times in

one year and were diagnosed with schizophrenia at

least five years ago.

Table 1: Demographic profile of participants (family).

Characteristics

Sex

Female

66.67

Male

33.33

Age (Years)

26–35

6.67

36–45

46–55

46.67

56–65

26.66

Relationship to

schizophrenic

patients

Mother

46.67

Father

13.33

Spouse

13.33

Child

6.67

Siblings

13.33

Sisters-in-law

6.67

Educational level

Elementary

33.34

Junior High

13.33

Senior High

University

Non-schooled

13.33

Employment

Civil-

government

6.67

Private

employment

46.67

Self-employed

13.33

Not working

33.33

Resiliency Experiences of Family Members Who Take Care of Patients with Schizophrenia

Table 2: Demographic profile of participants

(patients).

Characteristics

Sex

Female

Male

Age

(Years)

20–25

26–35

26.67

36–45

13.33

46–55

13.33

56–65

6.67

Employment

Painter

6.67

Tailor

6.67

Not working

86.66

Control pattern

Regularly

Unregularly

Duration of

illness

(years)

5–10

73.34

>10

26.66

Frequency of

relapse

within 1 year

3-5

53.33

46.67

3.2 Phase of Family Resilience

Five themes were abstracted from the family’s

experiences related to family resilience when taking

care of patients with schizophrenia. The themes are:

surviving the existing situation, trying to make

changes in the family structure, trying to accept

family members experiencing schizophrenia,

looking for positive meaning in the difficulties, and

providing support to the family and others who care

for patients with schizophrenia. The details of each

theme are described in the following sections.

3.2.1 Surviving the Existing Situation

The families of Schizophrenic patients face high

levels of stress and struggle with their lives by

surviving the existing situation. Surviving the

various problems of the family is grouped into three

sub-themes, namely seeking information, fostering

family attachment, and reviving family spirituality.

Seeking information is done by the family to

understand the schizophrenia disease, how to treat it,

and how to care for patients suffering from

schizophrenia.

Searching for information about schizophrenia is

done by asking and searching various sources, for

example, one participant stated,

"... I read on the internet, what is schizophrenia?

And I understand our family lives with big

problems... it is not easy to overcome ..." (P2)

Attempts to seek information about treatment,

health care, and other alternatives, are carried out by

families as other participants explain

"... every consultation to my doctor, we always ask

the doctor, we really want to know, if all of these

drugs can immediately heal her (the patient), and the

nurses also explained that she should not stop taking

the drugs ..." (P13).

"… my neighbors said in another city, there is

someone who can cure the disease like this

(schizophrenia)... all our information is collected,

discussed with all family members and we decide...

which one is the best" (P2).

The families collect information on how to treat

schizophrenia patients by asking health workers and

other families who also treat patients with

schizophrenia, according to the following statement:

".. my question to the nurse (every nurse) every

hospitalization, is always the same ... how to not

relapse again ... the answer is the same, must take

medicine and give activities at home ..." (P8).

"... The family from another patient said if we can

give him a simple job and make him (the patient)

happy with his job, so finally we created a kiosk of a

gallon ... alhamdulillah, he enjoys it ... he can

manage the gallons’ distribution, count the money,

he sometimes needs help, but he is happy and indeed

his recurrence is not often..." (P6).

Families try to survive by growing attachment

involving all family members, growing mutual

ownership, and are always convinced that the family

is a strong team to overcome various arising

problems. Three participants explained family

efforts to foster attachment involves all family

members.

Families always maintain a sense of belonging to

strengthen attachment within the family as follows:

"... at the beginning of every month I gather my

children, I let them know so many times that our

mother was sick (schizophrenia), there are no others

that may help her, we are family ... we must be

together, don’t forget to greet your mother every day

... so all of you (children) still remember that of

having a mother... " (P15).

The families evoked the thought that they are a

strong team in treating patients with schizophrenia,

as the following expression explains:

".. after having a shower in the morning, he gets

breakfast, which is prepared by my wife (patients

sister-in-law), drinks coffee and smokes some

cigarettes ... then he (patient) help me open the shop,

he takes care of it. I will give some money to him

and the money also saves for medicine and his daily

needs. Another brother, he works in Jakarta always

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

supplies money for us. He is far away in the

distance, ... but we are like a solid team. No matter,

we have treated him (the patient), but the fund

already exists (from the brother) ... because we do

not have parents already.... We should be helping

each other..." (P12).

When faced with stressful situations, families try

to survive using spiritual aspects. Families think that

each situation that occurs is related to the caring

process is an ordeal from God; it is fate, so the

family should surrender to God. Five participants

said that many problems that arise today are

temptations from God, as these participants stated:

".... It is the ordeal... It is hard for us… but we

believe it is really from God..." (P6).

Eight participants claimed that the presence of a

schizophrenic patient in the family was God's

destiny as per the following quote:

"... we understand... it is our destiny ... to be given a

child like this (with schizophrenia) ..." (P7).

Ten participants expressed a sense of acceptance

during the care of a schizophrenic patient, according

to the following phrase:

".. it becomes easier after we are willing to accept

this condition; however, he is a member of our

family” (P15)

3.2.2 Trying to Make Changes in The Family

Structure

Families efforts to achieve family resilience by

changing the family structure includes three sub-

themes: flexibility, creativity, and initiative.

Flexibility in the family is achieved by dividing

roles and time in the family to treat patients with

schizophrenia. Role distribution is presented by the

following participants:

"... realizing that taking care of mother is not easy, I

asked my second child to tidy the house, cook,

cleanup, and buy daily needs. She already does a lot

for us (family). My first child had to create the

money for the treatment… and I will always stand

beside of my wife. You can imagine if we did not

divide the role of the family, it will be hard for

everybody... it is not good for her (patient)..." (P15)

Flexibility in the family is also achieved by sharing

and dividing the time to treat patients with

schizophrenia, as in the following statement:

".... I have to work, so it's impossible for me to

accompany my sister (the patient) in the afternoon,

so I ask my brother who lives in the alley next door,

he is working at home, has a catering business. I

leave him (the patient) ...in the afternoon we go

home and that's my turn to guard my sister ... I must

divide my time, because all of us must work, yeah...

seek money, you see... we do not have parents

now..." (P14).

Family adjustments are made by fostering

creativity through seeking diversions and finding

new ways to cope with high levels of stress in the

family. Seeking diversions as an effort to decrease

boredom during caring is conveyed by four

participants as in the following quote:

"... when it is saturated, I even participate in routine

recitation in the mosque, I can be freed thinking of

my child's behavior, … it really entertained me... I

met many people and refreshed my mind." (P10)

The families foster creativity by finding new

ways to keep up their spirits and overcome

problems, such as the following participant’s

expression:

"... since my child was sick (schizophrenia), I

stopped sewing, my concentration is for my child, ...

but instead I was saturated, so I try ... initially not

sure, I invited him (patient) to join in sewing... I ask

him to sew ship napkin. Just simple sew, it turns out

and he likes it. We all are really happy to see him

and his new job. We are doing it together, I make the

pattern and he continues to sew. He gets money for

it" (P13).

Family adjustments are made by stimulating

initiatives among family members to undertake

treatment planning for schizophrenic patients

together and to help each other with ideas to

improve the situation. Planning of treatment for

schizophrenic patients was suggested by two

participants in the following quote:

"... sometimes there are times that we are stuck (at a

dead end), so we are calling my auntie and my

uncle, we are thinking together finding the best way

for her (patient). We bring her to a psychiatrist near

our auntie’s house. We feel not alone..." (P5)

Family initiatives such as openness to ideas are

valued in assisting family adjustments to stressful

situations, as three participants in the following

statement explain:

"... the tension in caring does make us think what a

misfortune this life is, but there’s always an idea to

make us feel happy. Sometimes my son invites all of

the family for family picnics to Bromo, included him

(patient).... he (the patient) is very happy and wants

more.... praise to God… we release our stress

together (smiles)" (P9).

3.2.3 Trying to Accept Family Members

Experiencing Schizophrenia

Family resilience requires families to accept

Resiliency Experiences of Family Members Who Take Care of Patients with Schizophrenia

schizophrenic patients and their situations. Family

acceptance is illustrated in the sub-theme of family

communication and a strong commitment to struggle

together and solve all problems with the family.

Two-way communication in the family means

listening to each other's complaints about heavy

burdens, recounting the success and difficulties of

caring for the patient. Listening to each other's

complaints can create a sense of relief as stated in

the following quotation:

"…if it's annoying me (the patient’s behavior), I will

call my husband, telling him everything. When he

(husband) arrives home, I tell him again (smiles)...

until I feel relief... and ready to face another problem

(the son with schizophrenia)" (P6).

Telling success in dealing with unruly patients’

behavior fosters pride and motivation for the family

to stand upright and always treat patients well, like

the following participant expresses:

"... the house was overwhelmed by how to face

him (patient), I was wondering when he would be

invited for a hospital visit, I talked to him, that was

nice, and I promise him, will buy anything he wants

.... anyway, there is money sorted out ... (laughs)"

(P11).

Admitting difficulties during patient care is

another way of evaluating and fostering a unique

feeling of sharing stories within the family, as the

following participants say:

"... ever it is a failed story, I told my sister when

she gets hallucinations ... I say, do not listen, it is a

devil and she is getting angry, throwing the sandals

at me. At the other times, my brother also does it to

my sisters and she threw a new branded backpack at

my brother and he gets the new backpack, really

branded backpack (laugh). So, I have a plan to get

some other branded things from her (laugh). It's

funny for us" (P14).

Adjustment of family situations requires a

commitment from the family. Family commitments

are grouped into two parts: agreeing on situations as

a common problem and trying to resolve them.

Agreements about realizing it is a joint problem was

described by six participants in the following

statement:

"... we talked well, there must be willingness and

openness, that this is not the fault or the truth of one,

but this is a problem for all... and we feel better... "

(P14).

3.2.4 Looking for Positive Meaning in Difficulty

Family resilience requires a turning point during

which the family can rise from stressful situations

they experience. The ability of families to find

positive meaning in their difficulties makes the

family grow stronger. It is divided into two parts:

positive judgment and positive behavior. Positive

judgment is described by participants through

expressions of patience, sincerity, bravery, and

confidence after experiencing extraordinary tension

during the care of patients with schizophrenia.

Patience was discussed by 12 participants as in the

following statement:

".... all the problems because of him (patient), makes

me able to be extraordinary patient, my friend said, I

have bought a lot of patience" (P7)

Sincere expression was discussed by eight

participants, for example: ".... I was willing if my

life was only for my sick child ... I suppose sincerely

I live ...." (P3).

A positive judgment of the situation was said to

be a family's strength, as the following participant

discloses:

"... we all can learn… all the problems will find a

way ... so many problems become common and

resolved..." (P8).

Participants also conveyed growing confidence

when experiencing difficult times and state that it is

a family strength in the face of further challenges, as

the following quote suggests:

"... I feels proud… proud of my family, when my

sister gets relief, willing to help the family... I really

want to inform another family (who are already

taking care of a patient) ... she (the patient) is getting

better. ... God willing, if there is a problem again we

are better prepared..." (P14).

3.2.5 Providing Support to Other Families Who

Also Care for Patients with Schizophrenia

Families who have attained resilience can also

independently provide support to other families who

experience similar situations. Eight participants

delivered extraordinary achievements: the ability to

help other families through emotional,

informational, and strengthening support. Emotional

support is provided in the form of a willingness to be

a good listener and provide a positive response when

other families need support, such as quotes from the

following participants:

".... I've experienced what they (other families)

experienced, my neighbor was very sad (his son

suffered from schizophrenia) ... I listened to him, he

is crying, yes... I let him cry a lot... and he feels

better soon” (P3)

"... my aunt, her son was the same as my son

(schizophrenia), my aunty often come to my house.

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

She tells me all of her thoughts... just listening to her

… she will get better” (P9)

Informational support is provided by participants

around treatment information, how to deal with

patients in relapse and prevent recurrence, such as

the following participant expressed:

"... sharing about the medicine, because they (the

patients with schizophrenia) easily get bored taking

the medicine" (P4).

"... I always tell them (another family) ... the

important thing is staying calm when the patient

relapses ... once she is in stable condition, give the

activities that make her feel happy and appreciated

..." (P7).

Support is also given by participants related to

the reinforcement to keep the family upbeat and

unyielding, such as the following participant states:

"... caring for her (schizophrenic patient) is not easy.

Talking with another family always gives the spirit

... that will always be the best topic... (laughs)"

(P15).

4 DISCUSSION

4.1 Surviving the Existing Situation

While caring for patients with schizophrenia,

families face high stress but still strive to live: this is

called survival. Surviving various problems of the

family is grouped into three sub-themes, namely

seeking information, fostering family attachment,

and reviving family spirituality. The findings of this

study are in line with Lietz (2016) who explains that

families will try to survive when faced with severe

problems and may not have thought to try new skills

to find solutions to existing problems. Families

when caring for schizophrenic patients will try to

struggle through life, facing a lot of problems.

Families try to find information about schizophrenia,

ask parties who they feel can help, but have not yet

acted to overcome the existing problems. Obtaining

information about the pain experienced by family

members keeps the family surviving for a while

without solving the problem (Amagai et al., 2016).

Families try to survive by strengthening bonds

between family members. An awareness of the fact

that the problems they face are common, and

unifying the view that families should provide

protection to patients with schizophrenia, makes

families feel better and able to survive (Amagai et

al., 2016). Spirituality is the potential possessed by

the family to foster strength. Families believe that all

the problems that exist with the presence of the

schizophrenic patients are trials and fate of God. The

family recognizes power beyond the strength of the

family that will give way out. The families’

spirituality fosters tranquility so they can survive.

4.2 Trying to Make Changes in the

Family Structure

Families achieve family resilience by modifying the

family structure. According to Lietz (2007), the

family will attempt to create various changes in the

function of the family, thus helping the family face

problems. This is called family adaptation. Families

that treat patients with schizophrenia will re-map the

roles and functions of their existing family. They

will try to arrange agreements with the family to

share roles.

The role of parenting tends to be a burden to

close family members and understand with the

patient and not in working condition. The role of

workers is charged to family members who can

sustain family life by working. The division of roles

and duties within a family is adjusted to change the

perception of the family to be more positive in

taking care of schizophrenia patients.

This research explains that families develop

flexibility, creativity, and initiative. Alternative

solutions are delivered by family members when

discussing what the family should do.

Unprecedented attempts, such as bringing patients to

traditional and alternative medicine, often become

‘family pruning’. All efforts are made to cure the

patient with schizophrenia.

4.3 Accepting Family Members

Experiencing Schizophrenia

Family resilience requires families to manage

schizophrenic patients and situations due to the

presence of a patient within the family. The

acceptance stage will be passed by the family where

the family will, in time, receive a new reality for the

family (Lietz et al., 2016). As a result, the family

will declare acceptance that one member of his

family is experiencing schizophrenia and must be

shared along with existing constraints. Family

acceptance is illustrated in the sub-theme of family

communication and a strong commitment to work

together and solve the problems within the family.

Families develop an open communication pattern

among its members to convey the anxiety, sadness,

failure, and success achieved during caring for a

schizophrenic patient. Good communication will

foster a sense of mutual understanding, not feeling

Resiliency Experiences of Family Members Who Take Care of Patients with Schizophrenia

alone, and fostering a strong commitment. Family

awareness of the strength and commitment of the

family also decreases the expectation gap, in which

the family is willing to accept the patient's condition

of schizophrenia as it is (Amagai et al., 2016).

Achievement of the acceptance of the family needs

to be supported so that the family becomes stronger

when facing difficulties.

4.4 Looking for Positive Meaning in

Difficulty

Family resilience requires a turning point at which

the family can rise from the stressful situation. The

family's ability to grow stronger is achieved once the

family can find positive meaning in the difficulties.

Lietz (2016) explains that the family situation can

become stronger due to various problems and

families find the meaning of the struggle that has

been undertaken. The positive meaning that the

family feels was discussed by most participants and

can be observed in two areas: positive judgment and

positive behavior. This situation requires the ability

of families to provide deep meaning within the

difficult problems.

This study suggests that families are beginning to

provide positive judgment of the difficulties they

experienced, such as being more patient, brave,

confident, and surrender to God. A positive

judgment stimulates the family to think clearly and

behave positively. Problems that initially felt

difficult to perceive are a thing that leads to good, so

they can find a way out. Families who treat patients

with schizophrenia understand that having family

members with schizophrenia has constraints, but

they are not all negative. These constraints can

provide wisdom that makes families grow stronger.

4.5 Providing Support to Other

Families Who Also Care for

Patients with Schizophrenia

Families who have attained resilience are not only

able to survive and rise from the stress that has been

experienced during the care of schizophrenic

patients but are also able to independently provide

support to other families experiencing similar

situations and conditions. Eight participants

delivered an extraordinary achievement: the ability

to help other families through emotional,

informational, and strengthening support. Families

stand firm and strong with the ability to overcome

various problems and obstacles, and have proud

experience in the process of solving problems and so

have the desire to help others in solving problems

(Lietz 2007).

This research explains that families are willing

to listen to others as a form of empathy and

emotional support. Families in this study provided a

variety of information about treatment and how to

care for patients at home and share their experiences

with other families who are overcoming similar

problems during the care of patients. Families do not

hesitate reward and praise the actions of other

families with whom they give spirit and reassurance

that they are not alone and that there are many who

solve similar difficulties.

5 CONCLUSIONS

Families caring for schizophrenic patients require

resilience: to survive, overcome, and get better.

Families achieving resilience experienced five

stages: surviving the existing structure, trying to

accept family members experiencing schizophrenia,

looking for positive meaning in difficulties, and

providing support to the families of others who also

care for patients with schizophrenia. Families who

have attained family resilience have a formidable

ability to deal with various problems. Finding

positive meaning will become a turning point for a

family to grow stronger and achieve resilience.

These aspects empower families to think rationally,

build self-confidence, rise from stressful situations

and crises, and develop more positive behaviors.

Health workers, especially mental nurses, may

review the stages of family resilience to develop

appropriate intervention strategies for improving

family resilience. Subsequent research should focus

on developing a family-based resilience model for

nursing to improve the treatment of patients with

schizophrenia.

ACKNOWLEDGMENTS

We would like to thank the family members and

schizophrenic patients who were participants in this

research. We also appreciate the support from all the

nurses and staff of Menur Health Mental Hospital

Surabaya Indonesia for all their facilitation during

this research.

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

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