Introduction Schizophrenia is a chronic, severe, and disabling brain disease.

Although schizophrenia affects men and women with equal frequency, the disorder often appears earlier in men, usually in the late teens or early twenties, than in women, who are generally affected in the twenties to early thirties. People with schizophrenia often suffer terrifying symptoms such as hearing internal voices not heard by others, or believing that other people are reading their minds, controlling their thoughts, or plotting to harm them. These symptoms may leave them fearful and withdrawn. Their speech and behavior can be so disorganized that they may be incomprehensible or frightening to others. Available treatments can relieve many symptoms, but most people with schizophrenia continue to suffer some symptoms throughout their lives; it has been estimated that no more than one in five individuals recovers completely (NIMH, 2007). Schizophrenia usually is diagnosed in late adolescence or early adulthood. Rarely does it manifest in childhood. The peak incidence of onset is 15 to 25 years of age for men and 25 to 35 years of age for women (America Psychiatric Association, 2000). Paranoid Schizophrenia is the most common type of schizophrenia in most parts of the world. The clinical picture is dominated by relatively stable, often paranoid, delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances. Disturbances of affect, volition, and speech, and catatonic symptoms, are not prominent. Patients who have paranoid schizophrenia that has a thought disorder may be obvious in acute states, but if so it does not prevent the typical delusions or hallucinations from being described clearly. Affect is usually less blunted than in other varieties of schizophrenia, but a minor degree of incongruity is common, as are mood disturbances such as irritability, sudden anger, fearfulness, and suspicion. "Negative" symptoms such as blunting of affect and impaired

volition are often present but do not dominate the clinical picture. The course of paranoid schizophrenia may be episodic, with partial or complete remissions, or chronic. In chronic cases, the florid symptoms persist over years and it is difficult to distinguish discrete episodes. The onset tends to be later than in the hebephrenic and catatonic forms (Schizophrenia.com, 19962004). Family members can play an important role in helping to keep their schizophrenic relatives supported and oriented. Before they can be properly supportive, however, they must first understand and accept that schizophrenia is a disorder of the brain just like diabetes is a disorder of the body; not anyone's fault; and not an indication of moral or spiritual failure. Family members need to know this so that they do not blame their schizophrenic relatives for being schizophrenic, or think of them as willfully lazy. Patients are often incapacitated, and a drain on family energy and resources, but this is not intentional on the part of patients, who are in many ways victims more than anything else (Dombeck and Nemade, 2006). The love and support of family plays an important role in schizophrenia treatment and recovery. If someone close to you has schizophrenia, you can make an enormous difference by helping that person find the right treatment, obtain benefits, and cope with symptoms. You can also play a crucial role by encouraging your loved one and offering support as he or she embarks on the long journey to recovery. But you also need to take care of yourself. Youll be better equipped to assist your family member if you draw on the support of others and take advantage of supportive services in your community. Dealing with a family members schizophrenia can be tough, but you dont have to do it alone (Segal and Smith, 2011).

According to the World Health Organization, It describes statistics about mental disorders of year (2008). Schizophrenia is a severe form of mental illness affecting about 7 per thousand of the adult population, mostly in the age group 15-35 years. Though the incidence is low (3-10,000), the prevalence is high due to chronicity. According to the facts it reveals Schizophrenia affects about 24 million people worldwide. Schizophrenia is a treatable disorder, treatment being more effective in its initial stages. More than 50% of persons with Schizophrenia are not receiving appropriate care. Ninety percent of people with untreated schizophrenia are in developing countries. Care of persons with schizophrenia can be provided at community level, with active family and community involvement.

Schizophrenia affects men and women with equal frequency. Schizophrenia often first appears in men in their late teens or early twenties. In contrast, women are generally affected in their twenties or early thirties.

In the Philippine setting, the disability survey in 2000 by the National Statistics Office (NSO) found out that mental illness was the third most common form of disability in the country. The prevalence rate of mental disorders was 88 cases per 100,000 populations and was highest among the elderly group. This finding was supported by a more recent data from the Social Weather Station Survey commissioned by DOH in 2004. It reveals that 0.7 percent of the total households have a family member afflicted with mental disability. The Baseline Survey for the National Objectives in 2000 stated that the more frequently reported symptoms of an underlying mental health problem were sadness, confusion, forgetfulness, no control over the use of cigarettes and alcohol, and delusions.

The most recent study on the prevalence of mental health problems was conducted by the National Epidemiology Center (DOH-NEC) in 2006 which showed revealing results through the target population was limited only to government employees from 20 national agencies in Metro Manila. Among 327respondents, 32 percent were found to have experienced a mental health problem at least once in their lifetime. The three most prevalent diagnoses were: specific phobias (15%), alcohol abuse (10%), depression and schizophrenia (6%). Mental health problems were significantly associated with the following respondent characteristics: ages: 20-29 years, those who have big families, and those who had low educational attainment. The prevalence rate generated from the survey was much higher than those that were previously reported by 17 percent. (doh.gov.ph, 2007) Statement of the Problem This research will explore the lived experiences of immediate family members in dealing with paranoid type schizophrenic member of the family. Specifically, shall seek answer on the following questions: 1. What is the quality of life of immediate members of the family in dealing with family members afflicted with Paranoid type Schizophrenia? 2. What themes might be derived from the lived experiences of immediate members of the family? SCOPE AND DELIMINATION The scope of this study includes paranoid type schizophrenic patients regardless of their age and gender. Its main purpose is to know the lived experiences of the relatives of these

patients. The respondents would be the relatives of the chosen paranoid type schizophrenic patients where they will be asked some questions on how they deal with the patients that has the disorder. SIGNIFICANCE OF THE STUDY The researchers had been very interested to patients with schizophrenia especially to the relatives of these patients. It caught their interest as to how relatives of paranoid type schizophrenic patients cope and deal with their condition. It also has been said that there is a growing number of people having paranoid type- schizophrenia; digging deeper about this study can yield benefits not only to the patients and relatives but also to the nursing world. The result of this study will help nurses understand what relatives of paranoid type schizophrenic patients really think and feel. Whatever information yielded from this study can help in nursing education, nursing practice and nursing research. In nursing education, the study can yield useful information to understand further the feelings of the relatives of paranoid type schizophrenic patients. The information can help discover techniques in managing feeling of these relatives, thus will be taught to nurses and to other health professionals. In nursing research, this study can add up to the vast knowledge the nursing world has. Furthermore, other researchers might build curiosity and further deepen this study which can in turn, venture more discoveries about paranoid type schizophrenic patients in the future. In nursing practice, this study can help nurses use the appropriate approach to relatives of paranoid type schizophrenic patients, after understanding their insights. There will be effective nurse-patient relationship and goals among nurses and patients shall be met.

RESEARCH PARADIGM ADAPTATION MODEL (Sister Callista Roy)

Input Output
Stimuli Adaptive and Adaptation ineffective Level responses

Control Processes
Coping mechanisms Regulator Cognator

Effectors
Physiological function Self-concept Role function Interdependence

Feedback

Roys model focuses on the concept of adaptation of the person. Her concepts of nursing, person, health, and environment are all interrelated to this central concept (Tomey & Alligood, 2002). As an open living system, the person receives input or stimuli from both the environment and the self. The adaptation level is determined by the combined effect of the focal, contextual, and residual stimuli. Focal stimuli are those that immediately confront the individual in a particular situation. Focal stimuli for a family include individual needs; the level of family adaptation; and changes within the family members, among the members and in the family environment (Roy, 1983). Patients with paranoid delusions have a vast concern regarding this matter because their behavior as a family member plays a great deal on how they respond on every situation as a unit. Contextual stimuli are those other stimuli that influence the situation. Residual stimuli include the individuals beliefs or attitudes that may influence the situation. Contextual and residual stimuli for a family system include nurturance, socialization, and support (Roy, 1983). These influences on the family also affect their relationships with one another. The level of nurturance, socialization, and support given to each member of a family may aggravate or ease a situation they are in like having a patient with paranoid delusions living with them. How they provide care with one another may help them develop better ways to interact to those with unfavorable characteristics.

There are two interrelated subsystems in Roys model. The primary, functional, or control processes subsystem consists of the regulator and the cognator. The secondary, effector subsystem consists of four adaptive modes: physiological needs, self-concept, role function, and interdependence (Tomey & Alligood, 2002). Roy views the regulator and cognator as methods of coping. The regulator coping subsystem, by way of physiological adaptive modes, responds automatically through neural, chemical, and endocrine coping processes. The cognator coping subsystem , by the way of self concept, interdependence and role-function adaptive modes responds through four cognitive-emotive channels: perceptual information processing, learning, judgment, and emotion. Perception of the person links the regulator with the cognator in that input into the regulator is transformed into perceptions. Perception is a process of the cognator. The responses following perception are feedback into both the cognator and the regulator (Tomey & Alligood, 2002). The person continually scans the environment for stimuli. Ultimately, a response is made and adaptation occurs. That adaptive response may be either an adaptive or an ineffective response. Adaptive responses are those that promote integrity and help the person to achieve the goals of adaption: that is survival, growth, reproduction, mastery, and person and environmental transformations. Ineffective responses are responses that fail to achieve the goals of adaptation (Tomey & Alligood, 2002). Adaptation occurs when the total stimuli fall within the individuals/familys adaptive capacity, or zone of adaptation. The inputs for a family include all of the stimuli that affect the family as a group. The outputs of the family system are three basic goals: survival, continuity, and growth (Roy, 1983). Roy states (Clements and Roberts, 1983): Since adaptation level results from the pooled effect of all other relevant stimuli, the contextual and residual stimuli associated with the focal stimulus should be examined to ascertain the zone within which positive family coping can take place and to predict when the given stimulus is outside that zone and will require an intervention.

DEFINITION OF TERMS Schizophrenia Conceptual: a psychotic disorder characterized by loss of contact with the environment, by noticeable deterioration in the level of functioning in everyday life, and by disintegration of personality expressed as disorder of feeling, thought (as delusions), perception (as hallucinations), and behavior (http://dictionary.reference.com/browse/compulsions) Operational: a psychotic disorder that impairs ones relationship with people and environment Dealing Conceptual: conduct in relations to others; treatment. (http://dictionary.reference.com/browse/compulsions) Operational: how one copes or interacts in prevailing situation. Relative Conceptual: a person who is connected with another or others by blood. (http://dictionary.reference.com/browse/compulsions) Operational: anyone related through blood RESEARCH METHOD

In this qualitative study, the researchers use the descriptive phenomenological approach as this approach best fits on how to explore the personal experiences of the relatives of paranoid type schizophrenic patients. Descriptive Phenomenology insists on the careful description of ordinary conscious experience of everyday life- a description of "things" as people experience them. These "things" include hearing, seeing, believing, feeling, remembering, deciding, evaluating, acting and so forth. This approach seeks to describe lived experience, also this approach strives to bracket out preconceived views and to intuit the essence of phenomenon by remaining open to meanings attributed to it by those who have experienced it. The study design typically evolves over the course of the project. Nevertheless, patterns emerging in the data often suggest that certain comparisons are relevant and illuminating. The researchers used an emergent design, a design that emerges as researchers make ongoing decision reflecting what has already been learned. As noted by Lincoln and Guba (1985), an emergent design in qualitative studies is not the result of sloppiness or laziness on the part of researchers, but rather a reflection of their desire to have the inquiry based on the realities and viewpoints of those under study-realities and viewpoints that are not known or understood at the outset. Emergent design approach results in emerging answers that will provide additional information that could help with the study. Also, this approach helps the researchers to formulate questions related to the problem. Researchers collected data from real-world, naturalistic setting and whereas, researchers strive to collect data in one type of setting to maintain control over the environment. (e.g. conducting all interviews in study participants' homes) RESEARCH LOCALE

The study will be conducted in Mother Teresa Home Care. The group chooses this kind of setting for it is more appropriate with regards to privacy and confidentiality of the topic. The area should be silent and must have a calming effect this would help in internalizing questions that would be ask on them. The group will also limit the number of individuals present in the scene; this is to let the person interviewing has her own way of asking questions on the relative. SAMPLE POPULATION The researchers will use a small, non random sample in which researchers will use different considerations in selecting study participants. The aim of most qualitative studies is to discover meaning and to uncover multiple realities, and so generalizablility is not a guiding consideration. The researchers will select an information-rich data source for the study. A critical first step in qualitative sampling is selecting settings with high potential for information richness. As the study progresses, new sampling questions will emerge. Thus, as with the overall design in qualitative studies, sampling design is an emergent one that capitalizes on early learning to guide subsequent direction. Glaser and Strauss (1967) noted that "incidents" or experiences are often the basis for analysis. An information-rich informant can therefore contribute dozens of incidents, and so even a small number of informants can generate a large sample for analysis. Researcher will select people who are knowledgeable, articulate, reflective and willing to talk at length with researchers so as to illicit information that will help to the study. The researchers will use purposive sampling strategy. That is, selecting cases that will most benefit the study. GRAND TOUR QUESTIONS

1. At what age was the schizophrenic member diagnosed? 2. How was the family affected after knowing the diagnosis? 3. Was there a stage of denial in the family? For how long? 4. How does a paranoid type schizophrenic patient interact with the family? 5. Is family bonding affected because of the disorder? 6. Are there any problems that emerged because of the member's disorder? 7. How does each family member cope with the situation? 8. Were there any activities that a schizophrenic member affects other activities of the other members? 9. Do the relatives always give way for a schizophrenic member? 10. Do the relatives consider them as burden in the family?

ETHICAL CONSIDERATION According to Polit and Beck edition 2008 Ethics is a system of moral values that is concerned with the degree to which research procedures adhere to professional, legal and social obligations to the study participants. Throughout the implementation of the study, the researchers applied the principles of beneficence, respect for human dignity and justice. a. Principle of Beneficence

Beneficence is one of the most fundamental ethical principles in research which encompass the maxim: Above all, do no harm. (Polit and Beck 8th edition 2008) Freedom from harm Throughout the study, the researchers strived to minimize all types of discomfort which can be physical, psychological, social and economic to achieve balance between potential benefits and risks of being a participant. (Polit and Beck 8th edition 2008) Freedom from Exploitation Involvement in a research study should not place participants at a disadvantage or expose them to situations for which they have not been prepared. (Polit and Beck 8th edition 2008)

b.

Principle of Respect for Human Dignity)

The researchers put into mind the observance of the principle of respect for human dignity. According to Polit and Beck edition 2008, respect for human dignity is the second ethical principle articulated in the Belmont Report which includes the following: Right to self determination Following the right to self determination which According to Polit and Beck edition 2008 is giving the participants the right to decide voluntarily whether to participate in the study without risking any penalty or prejudicial treatment, the researchers gave the subjects freedom to decide in their participation in the study.

Right to Full Disclosure According to Polit and Beck edition 2008, full disclosure is the full description of the researcher to the subjects of the nature of the study, the subjects right to refuse participation, the researchers responsibilities and the likely risks and benefits. The researchers described to the subjects the following details mentioned above to make sure that the subjects right to full disclosure was observed. c. Principle of Justice

The third principle as based on Polit and Beck edition 2008 is about justice. Justice includes participants right to fair treatment and their right to privacy. Right to Fair Treatment

The researchers made sure that the subjects observed the right to fair treatment. According to Polit and Beck edition 2008, it is a subjects right to having fair and equitable treatment before, during and after their participation in the study. Fair treatment includes the following features: respect for cultural and other forms of human diversity, honoring all agreements between researchers and participants, courteous and tactful treatment at all times, fair and nondiscriminatory selection of participants such that any risks and benefits will equitably be shared, non-prejudicial treatment of those who withdraw from the study after agreeing to participate, participants access to research personnel at any point in the study to clarify information Right to Privacy According to Polit and Beck edition 2008, this includes anonymity or the researcher making sure that subjects are not linked to their data. Throughout the study, the researchers kept in mind the importance of the subjects right to privacy and observed it throughout the study DATA GATHERING PROCEDURE The data will be collected by conducting interviews. According to Polit and Beck (2008), structured self-report data using a formal, written instrument is called an interview schedule. This is used when questions are asked orally in either face to face or telephone interviews. The researchers prefer to use this instrument because of its high response rates, its audience, clarity, depth of questioning, and supplication of missing information, order of questions, sample control and lastly, its potential for supplementary data. All the members of the group will participate in gathering data. The data will be collected from the relatives of chosen paranoid type

schizophrenic patients. Data is collected on July 2011 in Mother Teresa Home Care after the visitation time. Other steps made by the group are making a letter of permission for Mother Teresa Home Care to look for possible paranoid type schizophrenic patients then after finding patients, the researchers will look for their relatives and ask them if they can be interviewed for this study.