Journal of Psychosocial Nursing and Mental Health Services

CNE Article 

Ecological Predictors of Recovery-Oriented Practices Among Psychiatric Nurses in South Korea

Suyon Baek, PhD, RN

Abstract

Using hierarchical multiple regression analysis, the current study aimed to investigate ecological predictors of recovery-oriented practices among 230 psychiatric nurses in South Korea. Intrapersonal predictors associated with recovery-oriented practice were educational level, type of workplace, and attitudes regarding recovery. Extent of nursing practice environment recognized by nurses at the organizational level was also significant. Recovery-oriented practices were associated with intrapersonal and organizational factors. Therefore, it is necessary to provide multi-level considerations to improve recovery-oriented practices among psychiatric nurses. [Journal of Psychosocial Nursing and Mental Health Services, 58(11), 37–47.]

Abstract

Using hierarchical multiple regression analysis, the current study aimed to investigate ecological predictors of recovery-oriented practices among 230 psychiatric nurses in South Korea. Intrapersonal predictors associated with recovery-oriented practice were educational level, type of workplace, and attitudes regarding recovery. Extent of nursing practice environment recognized by nurses at the organizational level was also significant. Recovery-oriented practices were associated with intrapersonal and organizational factors. Therefore, it is necessary to provide multi-level considerations to improve recovery-oriented practices among psychiatric nurses. [Journal of Psychosocial Nursing and Mental Health Services, 58(11), 37–47.]

In the field of mental health care, recovery has been redefined based on the community mental health movement of the 1970s. One of the earlier definitions of recovery states that “mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of the person's choice while striving to achieve his or her full potential” (Ellison et al., 2018, p. 91). Based on this definition, a novel recovery paradigm is emerging. This paradigm encompasses the concepts of person-driven, many pathways, holism, peer support, relationships, culture, addressing trauma, strengths, responsibility, respect, and hope (Substance Abuse and Mental Health Services Administration [SAMHSA], 2012).

In South Korea (hereinafter referred to as Korea), the Mental Health Act was passed in 1995. This act led to community mental health services being widely available. In addition, the full revision to the Mental Health and Welfare Act in 2016 prescribed reinforcing the right to self-determination of people with mental illness and providing welfare services while considering people's quality of life (Ministry of Health and Welfare, 2016). Moreover, applying the concept of recovery to mental health services (National Mental Health Policy Solutions Forum, 2017) has recently become a topic of discussion and more studies are being performed to verify the effectiveness of recovery programs (Ha, 2019; Jung et al., 2019).

In other countries, providing recovery-oriented services has become a core value in the field of mental health services (Tondora & Davidson, 2006; U.S. Department of Veterans Affairs, 2008). Accordingly, health departments globally have developed a framework and set of guidelines for recovery-oriented practice (Department of Behavioral Health and Intellectual Disability Services, 2014; Mental Health Commission of Canada, 2015), and examined the effects of recovery-oriented practice (Cuddeback et al., 2013; Kidd et al., 2011; Rabenschlag et al., 2014; Wilrycx et al., 2015). Considering the field of nursing science, research on the status of recovery-oriented practice (McLoughlin & Fitzpatrick, 2008; McLoughlin et al., 2013) as well as the analysis and development of educational content applying the concept of recovery (Gale & Marshall-Lucette, 2012; Knutson et al., 2013) have been conducted. Furthermore, the American Psychiatric Nurses Association developed a recovery to practice curriculum in association with SAMHSA, and research on the implementation of recovery programs has also been conducted (Koval et al., 2016; McDonagh et al., 2019; Passley-Clarke, 2019).

To facilitate recovery-oriented practice, studies aimed at identifying the factors affecting recovery-oriented practice have been performed. However, most of these existing studies are qualitative (Cleary et al., 2013; Le Boutillier et al., 2015). Moreover, few studies have investigated the factors that affect recovery-oriented practices among nurses, who play a critical role in providing mental health services (McLoughlin & Fitzpatrick, 2008; McLoughlin et al., 2013). Furthermore, these studies only explored individual-level factors of nurses, such as age, and history of recovery-related education.

Nurses' intrapersonal factors are not the only ones in play while these professionals are delivering care within organizations. Group-level and situational variables may have a direct impact on individuals' attitudes and behaviors (Klein & Kozlowski, 2000). In fact, studies have reported that entering both individual nurse variables and group-level nursing unit variables expanded knowledge of nurses' individual performance (Ko, 2008), and that nursing group's empowerment affected individual empowerment behaviors (Purdy et al., 2010). In this context, it is necessary to multi-laterally examine the effect of interpersonal and organizational factors on recovery-oriented practices implemented by psychiatric nurses.

For this purpose, an ecological model is a useful approach to describe the importance of various environmental factors involved in human behavioral changes. The key premise of ecological models is that a multi-level intervention is the most effective for behavioral changes, and this is consistently supported by studies on various groups and environments (Centers for Disease Control and Prevention, 2006; Samuels et al., 2010).

Thus, the current study aimed to identify various factors at the intrapersonal, interpersonal, and organizational levels that influence recovery-oriented practice among psychiatric nurses using the ecological model suggested by McLeroy et al. (1988). The results of this study will serve as foundational data to promote recovery-oriented practice in the Korean psychiatric nursing field.

Method

Study Design

The current study used a descriptive correlational design to identify ecological factors that affect recovery-oriented practices among psychiatric nurses. The conceptual framework for the study was based on the ecological model of McLeroy et al. (1988) (Figure 1). In this model, intrapersonal factors are personal characteristics such as knowledge, attitude, behavior, self-concept, and skill. Interpersonal factors refer to the effects of formal and informal social relationships and social support, including family, co-workers, and friendships. Organizational factors refer to the characteristics of an organization that support the behavioral changes of its members. In this study, intrapersonal factors were psychiatric nurses' general characteristics and their knowledge as well as their attitude regarding recovery; interpersonal factors were group efficacy, group cohesion, and peer support. Lastly, the organizational factor was the nursing practice environment.

Conceptual framework of ecological predictors of recovery-oriented practices among psychiatric nurses.

Figure 1.

Conceptual framework of ecological predictors of recovery-oriented practices among psychiatric nurses.

Participants

The target population of the current study was psychiatric nurses working in psychiatric wards in hospitals or community mental health centers in Korea. The inclusion criterion was psychiatric nurses who voluntarily agreed to participate in the study, and exclusion criterion was administrative nurses who did not take care of patients in the nursing field at the time of the study.

Of the original 236 psychiatric nurses recruited from 11 settings using a convenience sampling method, 232 nurses agreed to participate. Data were collected from these 232 participants. Among them, two nurses who did not complete the survey questionnaires were excluded, and 230 nurses were included in the analysis. To conduct a multiple regression analysis, the calculation using G*Power 3.0.10 for Windows yielded a minimum sample size of 135 when the input included a medium effect size of 0.15, significance level of 0.05, power of 80%, and a maximum of 14 predictors.

Measures

Recovery-Oriented Practice. Recovery-oriented practice among participants was assessed with the Recovery Self-Assessment–Revised (RSA-R) scale developed by O'Connell et al. (2007). In the current study, the Korean version of the RSA-R, translated and verified for reliability and validity by Kim (2017), was used. The RSA-R consists of 32 items in five dimensions, including life goals (11 items), participation involvement (five items), diversity of treatment options (five items), choices (seven items), and individually tailored services (four items). On a 5-point Likert scale, each item was scored from 1 (strongly disagree) to 5 (strongly agree). Total score ranged from 32 to 160, with higher scores indicating higher levels of recovery-oriented practice. Regarding overall reliability, the original instrument showed a Cronbach's alpha of 0.96, and for the current study, Cronbach's alpha was 0.95.

Intrapersonal Factors

Intrapersonal factors consisted of general characteristics (e.g., age, educational level) and knowledge and attitudes regarding recovery.

Knowledge of Recovery. The Recovery Knowledge Inventory, developed by Bedregal et al. (2006) and revised by Kim (2010), was used to measure knowledge of recovery among participants. This 20-item scale was developed for mental health service providers and included the following dimensions: roles and responsibilities (seven items), non-linearity of the recovery process (six items), roles of self-definition and peers (five items), and expectations regarding recovery (two items). On a 5-point Likert scale, each item was scored from 1 (strongly disagree) to 5 (strongly agree). Total score ranged from 20 to 100, with higher scores indicating higher levels of knowledge of the concept of recovery. Regarding overall reliability, Cronbach's alpha of the original instrument was 0.81, and for the current study, Cronbach's alpha was 0.65.

Attitudes Regarding Recovery. The Recovery Attitudes Questionnaire-7, developed by Borkin et al. (2000) and revised by Choi and Choi (2007), was used to measure attitudes regarding recovery among participants. This questionnaire comprised seven items in two dimensions, including recovery is possible and needs faith (four items), and recovery is difficult and differs among people (three items). On a 5-point Likert scale, each item was scored from 1 (strongly disagree) to 5 (strongly agree). Total score ranged from 7 to 35, with higher scores indicating a more positive attitude regarding recovery. Regarding overall reliability, Cronbach's alpha of the original instrument was 0.70, and for the current study, Cronbach's alpha was 0.64.

Interpersonal Factors

Group Efficacy. Group efficacy was measured using the Collective Efficacy Belief Scale, developed by Riggs and Knight (1994). This scale consists of seven items, including five reverse-scored questions, such as “The members of my ward have excellent job knowledge (job skills),” and “My ward is not very efficient.” Each item was scored on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Total score ranged from 7 to 35, with higher scores indicating greater perceived group efficacy. Cronbach's alpha was 0.74 in a previous study (Ko, 2008), and 0.83 in the current study.

Group Cohesion. Group cohesion was measured using a tool modified by Yoon (2000) for the nursing population by revising the Group Environment Questionnaire developed by Carron et al. (1985). This questionnaire included 12 items, such as “My ward is more important than any other group I belong to,” and “My ward is united to provide quality of care.” Each item was scored on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), with total score ranging from 12 to 60. Higher scores indicate greater perceived group cohesion. Cronbach's alpha was 0.81 in a previous study (Yoon, 2000), and 0.85 in the current study.

Peer Support. Peer support was assessed using an instrument modified by Choi (2003), comprising three items, such as “I have a workmate who is very close to me,” and “I often hang out with my colleagues after work.” Each item was scored on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), with the total score ranging from 3 to 15 points. Higher scores indicate greater levels of perceived peer support. Cronbach's alpha was 0.65 in a previous study (Ko, 2008), and 0.69 in the current study.

Organizational Factors

Nursing Practice Environment. The Practice Environment Scale of the Nursing Work Index, developed by Lake (2002) and revised by Cho et al. (2011), was used to measure the nursing practice environment among participants. This index comprises 29 items in five dimensions, including nurse participation in hospital affairs (nine items); nursing foundation for quality of care (nine items); nurse manager ability, leadership, and support for nurses (four items); staffing and resource adequacy (four items); and collegial nurse–physician relations (three items). Each item was scored on a 4-point Likert scale, ranging from 1 (strongly disagree) to 4 (strongly agree). Total score ranged from 29 to 116, with higher scores indicating greater levels of perceived nursing practice environment. Regarding overall reliability of the original instrument, Cronbach's alpha was 0.82, and for the current study, Cronbach's alpha was 0.94.

Data Collection and Ethical Considerations

The current study was approved by the Institutional Review Board of the researcher's university. The researcher explained the purpose and method of the study to nursing managers in the hospitals and community mental health centers. Nurses from institutions that agreed to participate were selected as potential respondents. The purpose and method of the study were explained to participants and the survey was conducted only with nurses who voluntarily agreed to participate. Participants spent approximately 20 minutes completing the survey. A small gift was presented to the nurses upon completion of the survey.

Statistical Analysis

SPSS version 24.0 was used for data analyses. All data were screened to confirm their accuracy and ensure that the assumptions of the statistical tests were met. The reliability of the instruments used in the current study was verified with Cronbach's alpha coefficients. The level of recovery-oriented practice and the description of ecological factors of participants were analyzed using descriptive statistics. Correlational analysis was used to examine the correlation between major research variables. Hierarchical multiple regression analysis was used to investigate ecological predictors of recovery-oriented practice.

Results

General Characteristics of Participants

General characteristics of participants are shown in Table 1. Most (89.1%) participants were female. Mean age of participants was 40.24 years (SD = 9.97, range = 23 to 63), and 51.3% had a clinical career in psychiatry lasting ≥120 months. Most participants (80%) were graduates of 4-year colleges and universities. Most participants were general nurses (83.9%), and the most common patients cared for by participants were those diagnosed with schizophrenia and mood disorders (multiple response questions). Only 36.1% of participants indicated they had received recovery-related education (Table 1).

General Characteristics of Participants (N = 230)

Table 1:

General Characteristics of Participants (N = 230)

Psychiatric Nurses' Recovery-Oriented Practice and Related Ecological Predictors

Mean total recovery-oriented practice score was 3.53 (SD = 0.57, range = 1 to 5). Of the five subdomains of recovery-oriented practice, individually tailored services had the highest mean score at 3.84 (SD = 0.51), followed by life goals at 3.56 (SD = 0.57), 3.35 (SD = 0.71) for choices, and 3.33 (SD = 0.77) for involvement. Mean diversity of treatment options score was 3.32 (SD = 0.76), the lowest among the five subdomains. Participants' mean total knowledge of recovery was 3.09 (SD = 0.32, range = 1 to 5), and mean score for attitudes regarding recovery was 4.14 (SD = 0.41, range = 1 to 5). Mean group efficacy perceived by participants was 3.93 (SD = 0.68, range = 1 to 5), perception of group cohesion was 3.5 (SD = 0.6, range = 1 to 5), and peer support was 3.32 (SD = 0.79, range = 1 to 5). Regarding organizational factors, overall mean of nursing practice environment score was 2.56 (SD = 0.41, range = 1 to 4) (Table 2).

Psychiatric Nurses' Recovery-oriented Practices and Related Ecological Predictors (N = 230)

Table 2:

Psychiatric Nurses' Recovery-oriented Practices and Related Ecological Predictors (N = 230)

Differences in Recovery-Oriented Practice According to General Characteristics

Statistically significant differences in recovery-oriented practices according to general characteristics were observed in terms of age (F = 8.072, p < 0.001), length of clinical career in psychiatric departments (F = 3.236, p = 0.041), educational level (F = −3.512, p = 0.001), type of workplace (F = −3.193, p = 0.002), job position (F = −2.186, p = 0.030), and educational experience regarding recovery (F = −4.398, p < 0.001). Participants aged ≥50 years had higher levels of recovery-oriented practice than those younger than 30. Further, participants with >10 years of experience in psychiatric departments had higher recovery-oriented practice levels than nurses with <5 years of experience, and community center nurses had higher levels than those working in hospitals. Head nurses and team leaders had higher recovery-oriented practice levels than general nurses, and nurses with educational experience related to recovery also showed higher levels (Table 3).

Difference in Recovery-Oriented Practices According To General Characteristics (N = 230)

Table 3:

Difference in Recovery-Oriented Practices According To General Characteristics (N = 230)

Correlation of Intrapersonal, Interpersonal, and Organizational Predictors with Recovery-Oriented Practice

There were significant correlations between intrapersonal, interpersonal, and organizational factors and recovery-oriented practice. Attitude regarding recovery (r = 0.390, p < 0.001), group efficacy (r = 0.218, p = 0.001), group cohesion (r = 0.373, p < 0.001), peer support (r = 0.323, p < 0.001), and the nursing practice environment (r = 0.591, p < 0.001) showed significant correlations with recovery-oriented practice (Table 4).

Correlation of Intrapersonal, Interpersonal, and Organizational Predictors with Recovery-Oriented Practices (N = 230)

Table 4:

Correlation of Intrapersonal, Interpersonal, and Organizational Predictors with Recovery-Oriented Practices (N = 230)

Ecological Predictors of Recovery-Oriented Practice

Hierarchical multiple regression analysis was used to identify factors associated with recovery-oriented practice of psychiatric nurses. Prior to the analysis, the multicollinearity among the variables hypothesized to influence recovery-oriented practice was assessed by examining the tolerance and variance inflation factor (VIF) values. However, the results indicated that the VIF value was <3 and the tolerance value was >0.3 for all variables, confirming that multicollinearity was not an issue. Hierarchical multiple regression analysis was conducted, which considered age, clinical career in psychiatric departments, educational level, type of workplace, job position, educational experiences related to recovery, and attitude regarding recovery for the intrapersonal domain (Model 1); group efficacy, group cohesion, and support from peers for the interpersonal domain (Model 2); and nursing practice environment for the organizational domain (Model 3). Results are shown in Table 5.

Ecological Predictors of Recovery-Oriented Practice in Hierarchical Regression Models (N = 230)

Table 5:

Ecological Predictors of Recovery-Oriented Practice in Hierarchical Regression Models (N = 230)

Explanatory power was 29.7% (p < 0.001) for Model 1, which included factors in the intrapersonal domain. This model indicated that older age (β = 0.205, p = 0.022), higher educational level (β = 0.142, p = 0.014), community mental health center as the workplace (β = 0.245, p < 0.001), educational experience related to recovery (β = 0.176, p = 0.002), and positive attitudes regarding recovery (β = 0.351, p < 0.001) were associated with higher recovery-oriented practice. Regarding Model 2, with additional inputs related to factors in the interpersonal domain, explanatory power increased by 6.8% from Model 1 to 36.5% (p < 0.001), suggesting that greater perceived group cohesion (β = 0.258, p = 0.003) and peer support (β = 0.155, p = 0.012) predicted higher recovery-oriented practice. Regarding Model 3, with additional inputs related to factors in the organizational domain, explanatory power was 46.9% (p < 0.001), a 10.4% increase from Model 2, suggesting that greater perceived nursing practice environment (β = 0.396, p < 0.001) was associated with higher recovery-oriented practice. This model showed that, in addition to higher educational level, community mental health centers, such as the workplace, a positive attitude regarding recovery, and a positive nursing practice environment predicted higher recovery-oriented practice in psychiatric nurses.

Discussion

Studies that have investigated factors that affect recovery-oriented practices were mostly qualitative studies (Cleary et al., 2013; Le Boutillier et al., 2015). The current study adds to the research area by objectively measuring the degree of recovery-oriented practice among psychiatric nurses and by comprehensively exploring the factors involved at the intrapersonal, interpersonal, and organizational levels.

The mean overall recovery-oriented practice score was 3.53 of 5. In the study by McLoughlin and Fitzpatrick (2008), mean recovery-oriented practice score measured using a modified version of the RSA scale was 2.82 of 5 among nurses in a hospital setting. In another study on nurses in a hospital setting, McLoughlin et al. (2013) reported the mean recovery-oriented practice score to be 3.08 of 5 using the same instrument. In the current study, although the recovery-oriented practice score among nurses in a hospital setting (3.48) was lower than that among nurses working in a community setting (3.80), it was still higher than those reported in previous studies. This result may suggest that during the time period between previous studies, which were conducted in 2005 and 2011, respectively, and the current study, which was conducted in 2018, the need for recovery-oriented practices has grown and been shared among psychiatric nurses in Korea, which has led to more implementation of recovery-oriented practices among Korean psychiatric nurses. However, a score of 3.53 signifies that participants were performing each item of the recovery-oriented practice “somewhat” (3 = neutral) and “generally” (4 = agree). Thus, to improve the level of overall performance, appropriate support should be given to nurses based on an exploration of the factors that affect their recovery-oriented practice.

Results of the current study's univariate analysis showed that recovery-oriented practice differed according to age, clinical career in psychiatry departments, education, type of workplace, job position, and recovery-related education, which is partially consistent with results reported by McLoughlin and Fitzpatrick (2008) and McLoughlin et al. (2013). In the current study, participants who worked in a hospital showed a lower level of recovery-oriented practice than their counterparts working in a community center. This is in line with results pertaining to recovery-oriented practice measured using the RSA in 302 hospital staff and 182 community staff by Salyers et al. (2007; hospital staff = 2.80 [SD = 0.53], community staff = 3.25 [SD = 0.47]). The researchers explained that community staff typically encounter a more diverse group of consumers (e.g., employed and independent community-dwellers) than hospital staff, and hospital staff only encounter patients in need of hospitalization. Thus, collaborative measures such as cross-training, where nurses in hospital settings are given opportunities to work in community settings, may contribute to increasing recovery-oriented practice among hospital-based nurses in Korea. In addition to the findings of the current study, recovery-related education and training were identified to have an impact on recovery-oriented practice in qualitative studies, thus, the importance of education and training focused on the concept and principles of recovery cannot be overlooked.

However, although age, education, type of workplace, recovery-related education, and attitude regarding recovery were identified as statistically significant factors in our multivariate analysis with only intrapersonal factors, intrapersonal factors such as age and recovery-related education were not significant factors in the model that included organizational factors (nursing practice environment). This finding suggests that intrapersonal factors, such as recovery-related education, affect nurses' recovery-oriented practice when the nursing practice environment, an organizational factor, is perceived to be supportive of these practices. However, intrapersonal factors do not affect nurses' recovery-oriented practice when the nursing practice environment is not perceived as supportive of these practices.

Results of the multivariate analysis of interpersonal factors showed that interpersonal factors had a significant positive correlation with recovery-oriented practice, and in the regression model without organizational factors, group cohesion and peer support had a significant impact on recovery-oriented practices. However, group cohesion and peer support did not have a significant effect in the final regression model. This finding suggests that, similar to intrapersonal factors, interpersonal factors, such as group cohesion and peer support, affect nurses' recovery-oriented practice when the nursing practice environment is perceived to be supportive of these practices.

In a study on 76 nurses working in the field of mental health (Roche & Duffield, 2010), total score for perceived nursing practice environment was 2.70 (SD = 0.425) (nurse manager ability, leadership, support for nurses = 2.66 [SD = 0.750]; nursing foundation for quality of care = 2.60 [SD = 0.391]; staffing and resource adequacy = 2.58 [SD = 0.621]; collegial nurse–physician relations = 3.13 [SD = 0.616]; nurse participation in hospital affairs = 2.52 [SD = 0.487]). Participants in the current study perceived their nursing practice environment at a similar level to that of previous studies, and the score for the domain of staffing and resource adequacy was the lowest in the current study, also in line with previous studies.

In the current study, nursing practice environment, an organizational factor, affected nurses' recovery-oriented practices. A study that investigated organizational-level predictors that influence recovery-oriented practices among service providers in 12 mental health departments in California identified that innovation-oriented organizational culture, managers' transformational leadership, and budget were the factors that affected recovery-oriented practices (Brown et al., 2010). One study on 21 nurses working in an inpatient setting in Australia pinpointed inadequate staffing as a structural and organizational obstacle for recovery-oriented practices (Cleary et al., 2013). Thus, although no previous study investigated nursing practice environments in relation to its impact on recovery-oriented practices using the same instrument, the findings of the current study are in line with previous results. Although perceived nursing practice environment by psychiatric nurses is a major factor that affects recovery-oriented practices, psychiatric nurses' practice environment has been relatively neglected by Korean studies. Currently, psychiatric nursing fields in Korea are experiencing a shortage of nurses (Kwon et al., 2010). This shortage is related to psychiatric nurses' poor practice environments and burnout (Freeney & Tiernan, 2009), and this ultimately was associated with diminished quality of care (Winter et al., 2020).

Recovery-oriented practices have a negative correlation with consumers' length of hospital stay (Cuddeback et al., 2013; Kidd et al., 2011), and a positive correlation with consumers' employment status (Kidd et al., 2011), while empowering consumers and strengthening their potentials (Wilrycx et al., 2015). Moreover, recovery-oriented practices also resulted in positive outcomes for providers. In a comparison between providers in an acute ward who performed recovery-oriented practices and those who did not, the former group had statistically significant higher satisfaction with work conditions than the control group (Rabenschlag et al., 2014). In addition, a study on 114 case managers working in the community mental health field reported a heightened perception of occupational accomplishment and satisfaction with increasing recovery-oriented practices (Kraus & Stein 2013).

Previous studies implied that, as recovery-oriented practices have benefits for consumers and providers, they should be implemented in the field of psychiatric nursing in Korea. To this end, effective education and training pertaining to recovery should be provided to psychiatric nurses. Moreover, the findings of the current study highlight the importance of not only providing education and training at the intrapersonal level, but also improving current practice environments primarily by ensuring adequate staffing at the organizational level.

Conclusion

The current study identified the ecological predictors of recovery-oriented practice among Korean psychiatric nurses. Recovery-oriented practices were associated not only with intra-personal factors but also organizational factors. Therefore, to enhance recovery-oriented practice among psychiatric nurses, measures to improve overall nursing practice environment at the organizational level as well as education and training at the intrapersonal level should be considered.

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General Characteristics of Participants (N = 230)

Characteristicn (%)Mean (SD) (Range)
Age (years)40.24 (9.97) (23 to 63)
  ≤2940 (17.4)
  30 to 3976 (33)
  40 to 4954 (23.5)
  ≥5060 (26.1)
Sex
  Female205 (89.1)
  Male25 (10.9)
Clinical career in psychiatric departments (months)146.45 (111.97) (3 to 420)
  <6062 (27)
  60 to 11950 (21.7)
  ≥120118 (51.3)
Educational level
  College graduate46 (20)
  University graduate or higher184 (80)
Type of workplace
  Hospital193 (83.9)
  Community mental health center37 (16.1)
Job position
  General nurse193 (83.9)
  Head nurse/team leader37 (16.1)
Diagnosis of care recipienta
  Schizophrenia/mood disorder207 (90)
  Substance use34 (14.8)
  Other38 (16.5)
Educational experience related to recovery
  No147 (63.9)
  Yes83 (36.1)

Psychiatric Nurses' Recovery-oriented Practices and Related Ecological Predictors (N = 230)

VariablesCategoriesDomainsMean (SD)Range
IntrapersonalKnowledge of recoveryRoles and responsibilities3.19 (0.54)1 to 5
Non-linearity of the recovery process2.48 (0.49)
Roles of self-definition and peers3.86 (0.52)
Expectations regarding recovery2.28 (0.75)
Overall3.09 (0.32)
Attitude regarding recoveryRecovery is possible and needs faith4.05 (0.51)1 to 5
Recovery is difficult and differs among people4.26 (0.41)
Overall4.14 (0.41)
InterpersonalGroup efficacy3.93 (0.68)1 to 5
Group cohesion3.5 (0.6)1 to 5
Peer support3.32 (0.79)1 to 5
OrganizationalNursing practice environmentNurse manager ability, leadership, and support of nurses2.85 (0.49)1 to 4
Nursing foundation for quality of care2.75 (0.48)
Staffing and resource adequacy2.29 (0.6)
Collegial nurse–physician relations2.79 (0.51)
Nurse participation in hospital affairs2.58 (0.49)
Overall2.56 (0.41)
Recovery-oriented practiceLife goals3.56 (0.57)1 to 5
Involvement3.33 (0.77)
Diversity of treatment options3.32 (0.76)
Choice3.35 (0.71)
Individually tailored services3.84 (0.51)
Overall3.53 (0.57)

Difference in Recovery-Oriented Practices According To General Characteristics (N = 230)

CharacteristicMean (SD)tor FpValue
Age (years)8.072<0.001 (a<b)
  ≤293.2 (0.47)a
  30 to 393.51 (0.58)b
  40 to 493.58 (0.55)b
  ≥503.74 (0.53)b
Sex−1.3070.193
  Female3.55 (0.57)
  Male3.39 (0.51)
Clinical career in psychiatric departments (months)3.2360.041 (a<b)
  <603.41 (0.53)a
  60 to 1193.47 (0.6)a,b
  ≥1203.62 (0.56)b
Educational level−3.5120.001
  College graduate3.27 (0.5)
  University graduate or higher3.59 (0.57)
Type of workplace−3.1930.002
  Hospital3.48 (0.57)
  Community mental health center3.8 (0.44)
Job position−2.1860.03
  General nurse3.5 (0.54)
  Head nurse/team leader3.72 (0.67)
Diagnosis of care recipientc
  Schizophrenia/mood disorder1.5220.129
    Yes3.51 (0.57)
    No3.7 (0.46)
  Substance use−0.3420.732
    Yes3.56 (0.52)
    No3.53 (0.57)
  Other−1.3660.173
    Yes3.56 (0.52)
    No3.72 (0.67)
Educational experience related to recovery−4.398<0.001
  Yes3.74 (0.54)
  No3.41 (0.55)

Correlation of Intrapersonal, Interpersonal, and Organizational Predictors with Recovery-Oriented Practices (N = 230)

FactorsCategoriesrpValue
IntrapersonalKnowledge of recovery−0.3700.576
Attitude regarding recovery0.390<0.001
InterpersonalGroup efficacy0.2180.001
Group cohesion0.373<0.001
Peer support0.323<0.001
OrganizationalNursing practice environment0.591<0.001

Ecological Predictors of Recovery-Oriented Practice in Hierarchical Regression Models (N = 230)

VariableModel 1Model 2Model 3
βpValueβpValueβpValue
Age0.2050.0220.170.0490.1120.157
Clinical career in psychiatric departments−0.0260.776−0.0320.722−0.0180.82
Educational level (university or higher)0.1420.0140.1630.0030.1280.012
Type of workplace (community mental health center)0.245<0.0010.252<0.0010.236<0.001
Job position (head nurse/team leader)−0.0160.811−0.0370.559−0.0510.388
Educational experiences related to recovery (yes)0.1760.0020.1250.0260.0770.136
Attitude regarding recovery0.351<0.0010.282<0.0010.213<0.001
Group efficacy−0.1050.177−0.0460.520
Group cohesion0.2580.0030.0890.276
Peer support0.1550.0120.1070.058
Nursing practice environment0.396<0.001
Constant2.3000.0221.1120.2670.1440.886
R20.3190.3930.496
Adjusted R20.2970.3650.469
F14.85314.17419.416
P<0.001<0.001<0.001
Authors

Dr. Baek is Assistant Professor, Department of Nursing, College of Nursing and Health, Kongju National University, Chungcheongnam-do, South Korea.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Suyon Baek, PhD, RN, Assistant Professor, Department of Nursing, College of Nursing and Health, Kongju National University, 56, Gongjudaehak-ro, Gongju-si, Chungcheongnam-do, South Korea 32588; email: whitesy@kongju.ac.kr.

Received: March 26, 2020
Accepted: June 08, 2020

10.3928/02793695-20201013-07

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