The Effect of a Movie-Based Nursing Intervention Program on Rehabilitation Motivation and Depression in Stroke Patients

Hye Kyung Kwon; Sook Ja Lee

doi:10.4040/jkan.2017.47.3.345

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Kwon and Lee: The Effect of a Movie-Based Nursing Intervention Program on Rehabilitation Motivation and Depression in Stroke Patients

Original Article

J Korean Acad Nurs 2017;47(3):345-356.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.3.345

The Effect of a Movie-Based Nursing Intervention Program on Rehabilitation Motivation and Depression in Stroke Patients

Hye Kyung Kwon¹, Sook Ja Lee^2,

¹Department of Nursing, Graduate School of Chung-Ang University, Seoul,

²College of Nursing, Korea University, Seoul, Korea

Address reprint requests to : Lee, Sook Ja College of Nursing, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Korea Tel: +82-2-3290-4910 Fax: +82-2-928-9107 E-mail: scslee@korea.ac.kr

Received 9 September 2016 Revised 13 February 2017 Accepted 19 March 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The aim of this study was to develop and measure the effect of a movie-based-nursing intervention program designed to enhance motivation for rehabilitation and reduce depression levels in stroke patients.

Methods

The study used a quasi-experimental, nonequivalent control group and a pretest-posttest design. The 60 research subjects were assigned to the experimental (n=30) or control group (n=30). The movie-based nursing intervention program was provided for the experimental group during 60-minute sessions held once per week for 10 weeks. The program consisted of patient education to strengthen motivation for rehabilitation and reduce depression, watching movies to identify role models, and group discussion to facilitate therapeutic interaction.

Results

After 10 weeks of participation in the movie-based nursing intervention program, the experimental group's rehabilitation motivation score was significantly higher, F=1161.54 (within groups df=49, between groups df=1), p<.001, relative to that observed in the control group. In addition, the experimental group's depression score was significantly lower relative to that observed in the control group, F=258.97 (within groups df=49, between groups df=1), p<.001.

Conclusion

The movie-based nursing intervention program could be used for stroke patients experiencing psychological difficulties including reduced motivation for rehabilitation and increased depression during the rehabilitation process.

Keywords: Stroke, Rehabilitation, Depression, Motivations, Program development

References

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Figure 1.

Flow diagram.

Table 1.

Movie-Based Nursing Intervention Program for Stroke Patients

Session	Theme	Composition (Time)	Content
1	Meeting & new start	Patient education (10 min)	Introduction to the movie-based nursing intervention program
			The need for depression management and motivation for rehabilitation
		Movie appreciation (20 min)	Presentation of a video clips [Le Grand Chef 2; Kimchi War (2009)]
		Group discussion (20 min)	Group discussion based on structured questions
		Finish (10 min)	Discussion and reminders regarding resolutions
2	Self understanding &	Patient education (10 min)	The importance of self-understanding and acceptance of disability
	acceptance of disability	y	Learning how to accept disability
		Movie appreciation (20 min)	Presentation of a video clip [Miss Granny (2014)]
		Group discussion (20 min)	Group discussion based on structured questions
		Finish (10 min)	Discussion and reminders regarding resolutions
3	Expression of emotion	Patient education (10 min)	Emotional state of stroke patients
	& catharsis		Learning how to express emotion
			Learning how to relieve anxiety
		Movie appreciation (20 min)	Presentation of a video clip [Mama (2011)]
		Group discussion (20 min)	Group discussion based on structured questions
		Finish (10 min)	Discussion and reminders regarding resolutions
4	Stress management	Patient education (10 min)	Relationship between stroke and stress
			Learning how to relieve stress
		Movie appreciation (20 min)	Presentation of a video clip [The Foul King (2000)]
		Group discussion (20 min)	Group discussion based on structured questions
		Finish (10 min)	Discussion and reminders regarding resolutions
5	Improvements in	Patient education (10 min)	Association between health and personal relationships
	personal relationships		Training in personal relationship skills
		Movie appreciation (20 min)	Presentation of a video clip [I Love You (2010)]
		Group discussion (20 min)	Group discussion based on structured questions
		Finish (10 min)	Discussion and reminders regarding resolution
6	Improvements in the	Patient education (10 min)	The importance of the ability to practice self-determination
	ability to practice self		Five steps of self-determination
	-determination	Movie appreciation (20 min)	Presentation of a video clip [Pace Maker (2012)]
		Group discussion (20 min)	Group discussion based on structured questions
		Finish (10 min)	Discussion and reminders regarding resolutions
7	Finding hope and	Patient education (10 min)	The need for hope and purpose in life
	purpose in life		Establishment of hope and purpose in life
		Movie appreciation (20 min)	Presentation of a video clip [Castaway on The Moon (2009)]
		Group discussion (20 min)	Group discussion based on structured questions
		Finish (10 min)	Discussion and reminders regarding resolutions
8	Overcoming obstacles to	Patient education (10 min) o	Meaning and the need for motivation for rehabilitation
	rehabilitation		Learning how to overcome obstacles to rehabilitation
		Movie appreciation (20 min)	Presentation of a video clip [Forrest Gump (1994)]
		Group discussion (20 min)	Group discussion based on structured questions
		Finish (10 min)	Discussion and reminders regarding resolutions
9	Resources for	Patient education (10 min)	Types of resources for rehabilitation
	rehabilitation		Use of resources for successful rehabilitation
		Movie appreciation (20 min)	Presentation of a video clip [Blind (2011)]
		Group discussion (20 min)	Group discussion based on structured questions
		Finish (10 min)	Discussion and reminders regarding resolutions
10	Establishment of	Patient education (10 min)	The meaning of and need for an image of the future
	a positive image of		The effects of images of the future on stroke patients
	the future	Movie appreciation (20 min)	Presentation of a video clip [The Bucket List (2007)]
		Group discussion (20 min)	Group discussion based on structured questions
		Finish (10 min)	Discussion and reminders regarding resolutions

Table 2.

Homogeneity Test for General Characteristics between the Two Groups (N=51)

Characteristics	Categories	Total (n=51)	Exp. (n=24)	Cont. (n=27)	c²	p
		n (%)	n (%)	n (%)
Age (yr)	65~70	16 (31.4)	8 (33.3)	8 (29.6)	1.01	.601
	71~74	14 (27.5)	5 (20.8)	9 (33.3)
	≥75	21 (41.1)	11 (45.8)	10 (37.0)
Gender	Male	31 (60.8)	16 (66.7)	15 (55.6)	0.65	.417
	Female	20 (39.2)	8 (33.3)	12 (44.4)
Marital status*	Married	23 (45.1)	11 (45.8)	12 (44.4)	0.52	.797
	Bereaved	19 (37.3)	8 (33.3)	11 (40.7)
	Others	9 (17.6)	5 (20.8)	4 (14.8)
Education level	Ineducation	10 (19.6)	5 (20.8)	5 (18.5)	1.87	.600
	Elementary school	17 (33.3)	7 (29.2)	10 (37.0)
	Middle school	13 (25.5)	5 (20.8)	8 (29.6)
	High school	11 (21.6)	7 (29.2)	4 (14.8)
Duration after stroke*	<1 year	8 (15.7)	5 (20.8)	3 (11.1)	1.13	.839
	1~3 years	14 (27.4)	6 (25.0)	8 (29.6)
	3~5 years	10 (19.6)	4 (16.7)	6 (22.2)
	≥5 years	19 (37.3)	9 (37.5)	10 (37.0)
Type of stroke	Infarction	37 (72.5)	18 (75.0)	19 (70.4)	0.13	.712
	Hemorrhage	14 (27.5)	6 (25.0)	8 (29.6)
Number of occurrence	One	36 (70.6)	18 (75.0)	18 (66.7)	0.42	.514
	Two	15 (29.4)	6 (25.0)	9 (33.3)
Paralysis of body	Right	28 (54.9)	14 (58.3)	14 (51.9)	0.21	.642
	Left	23 (45.1)	10 (41.7)	13 (48.1)
Activities of daily living*	Independent	9 (17.6)	3 (12.5)	6 (22.2)	0.93	.630
	Partially dependent	23 (45.1)	12 (50.0)	11 (40.7)
	Almost dependent	19 (37.3)	9 (37.5)	10 (37.0)
Caregiver	Spouse	12 (23.5)	5 (20.8)	7 (25.9)	0.34	.874
	Offspring	9 (17.7)	4 (16.7)	5 (18.5)
	Care assistants	30 (58.8)	15 (62.5)	15 (55.6)
Medical cost payment	Patient	11 (21.6)	5 (20.8)	6 (22.2)	0.85	.654
	Spouse	10 (19.6)	6 (25.0)	4 (14.8)
	Offspring	30 (58.8)	13 (54.2)	17 (63.0)

Exp.=Experimental group; Cont.=Control group.

^*Fisher’s exact test.

Table 3.

Homogeneity Test for Outcome Variables between the Two Groups (N=51)

Variables	Exp.(n=24)	Cont.(n=27)	t	p
	Mean±SD	Mean±SD
Rehabilitation motivation	55.33±5.67	57.78±5.99	-1.49	.143
Depression	9.96±1.94	9.59±2.32	0.60	.548

Exp.=Experimental group; Cont.=Control group; SD=Standard deviation.

Table 4.

Changes in Rehabilitation Motivation and Depression with Implementation of the Movie-Based Nursing Intervention Program (N=51)

Variables	Groups	Exp.(n=24)	Cont.(n=27)	Sources	F	p
		Mean±SD	Mean±SD
Rehabilitation motivation	Pretest	55.33±5.67	57.78±5.99	Group	26.09	<.001
				Time	1,009.00	<.001
	Posttest	75.88±5.45	57.67±5.26	Group*Time	1,161.54	<.001
Depression	Pretest	9.96±1.94	9.59±2.32	Group	5.13	.014
				Time	202.93	<.001
	Posttest	6.92±1.56	9.78±2.03	Group*Time	258.97	<.001

Exp.=Experimental group; Cont.=Control group; SD=Standard deviation.

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