5.3. Environmental protective factors

These factors include effective family problem-solving and supportive psychosocial interventions.

Effective family problem-solving refers to the ability of family members to solve their problems, not only the individual problems of PDD but also the problems of all family members, which are always related to the conditions of each individual's life, his or her household, the neighborhood or town, and the larger community [5].

Social support: stress factors can exacerbate the psychotic symptoms. Therefore, the support from family, friends, medical specialists, or clinical practitioners represents the key components in helping persons to raise the protective factors for the reduction of symptoms severity.

Supportive psychosocial interventions: the combination of pharmacotherapy and psychosocial intervention has been recommended for treatment of PDD to reduce psychotic symptoms, and the individuals can be effectively engaged and continue the treatment [32]. In order to meet the goals of intervention in terms of reducing the stress of the patient, provide support for relapse prevention, promote adaptation of patient to living in the community, and facilitate continued decrease in symptoms and consolidation of remission, social support and supportive psychosocial interventions are recommended for the nursing role.

## 5.4. The environmental potentiates and stressor

According to the model, the environmental potentiates and stressor compose of the critical or emotionally over-involved attitudes toward the patient, an overstimulating social environment, and stressful life events.

The critical or emotionally over-involved attitude toward the patient is, namely, expressed emotion; according to this alternative model, there might not be a causal relationship between the highly expressed emotion (EE) of significant others and relapse; they might be jointly related to a third variable (severity of illness). Combine these two models by postulating feedback loops from behaviors of patient to attitudes and behaviors of significant others, thereby creating bidirectional influence patterns [29, 30].

environments, where context, temporal factors, and physical and psychological phenomena

Nursing Care for Persons with Drug Addiction http://dx.doi.org/10.5772/intechopen.73334 59

In conclusion, the prevalence of PDD can be as high and create vulnerability for drug use. Providing optimal care and intervention for this population such as (a) awareness and assessment about biological factors, (b) enhanced personal skill (coping skills, medication self-efficacy, informationprocessing skills, and social skill), (c) supportive psychosocial interventions, (d) social support, (e) expressed emotion program, (f) social function intervention, and (g) occupational functioning

Nursing interventions are helping PDD acknowledge the drug addiction and facilitating development of effective coping skills, medication self-efficacy, information-processing skills, occupational skill, and social skill by using the nursing process to (a) assessment information and health-care needs of PDD and (b) identified nursing diagnosis based on NANDA International (NANDA-1) classification system. Nursing diagnosis of PDD includes acute confusion,

Figure 1. Vulnerability-stress model of nursing intervention for PDD adapted from vulnerability-stress model [28–30].

program, these all require development and implementation of a best practice protocol.

6. Nursing care for persons with drug addiction

ineffective coping, and dysfunctional family process:

are inseparable (Figure 1).

This model views the social environment as stressful life events and highly expressed emotion. The occurrence of key life events leading to a high level of environmental stress interacts with preexisting biological vulnerability factors and increases the likelihood that psychotic symptoms will return. Additionally, critical and emotionally over-involved attitudes at least partially represent responses to the heavy burden that mental illness places on significant others and that the persons who have a more severe, relapse-prone form of illness place the heaviest burden on significant others.

For stressful life events, empirical data indicated that stressful life events rule on independent of the patient's behavior are more common in the weeks immediately before relapse. Additionally, the initial findings showed the roles of stress factors in other aspects of the early course of drug use that have significant associations with social functioning. Moreover, stressors in the form of stressful life events are realized as factors that interact with preexisting vulnerability characteristics to produce vicious circles, which lead, in turn, to psychotic episodes.

All of expressed emotion, both negatively expressed emotion and positively emotional expressed emotion, and stressful life events were included in nursing implementation for PDD.

## 5.5. Outcomes

This model indicated that the outcomes were social function, psychotic symptoms, and occupational functioning.

Social function (social dysfunction) is a hallmark characteristic of PDD that has important implications for the development, course, and outcome of illness. Additionally, social dysfunction generally worsens over the course of the disorder and is often resistant to drug treatment [31, 32].

Psychotic symptoms are a central element of drug use and are the outcome factors that reverse to other factors. Coping, self-efficacy, EE, stressful life events, and social functioning lead to the severity of psychotic symptoms that are exacerbated by drug use.

Occupational functioning of drug use is associated with a significant decrease in such functioning. "Less than 20% of individuals with PDD can maintain regular employment, and there is a relationship between psychotic symptoms and occupational functioning among PDD." Empirically derived factor structures have shown that symptoms fall into five components. One such factor structure is derived from the following components: positive, negative, hostility, cognitive, and emotional discomfort.

Occupational functioning is defined as competency with one's task performance associated with valued roles, sense of self-satisfaction, productivity, communication/interaction skills, leisure and rest in response to demands of the internal and/or external environment, and environments, where context, temporal factors, and physical and psychological phenomena are inseparable (Figure 1).

In conclusion, the prevalence of PDD can be as high and create vulnerability for drug use. Providing optimal care and intervention for this population such as (a) awareness and assessment about biological factors, (b) enhanced personal skill (coping skills, medication self-efficacy, informationprocessing skills, and social skill), (c) supportive psychosocial interventions, (d) social support, (e) expressed emotion program, (f) social function intervention, and (g) occupational functioning program, these all require development and implementation of a best practice protocol.
