Development of a nurse-observed functional recovery instrument for patients with chizophrenia: A preliminary pilot study

INTRODUCTION: Schizophrenia is a chronic mental disorder that impairs various functional domains of life. In Indonesia, most assessment tools used in mental health care remain focused on symptom measurement rather than functional recov-ery. There is a growing need for contextually relevant, nursing-based instruments to evaluate patients’ daily functioning through direct observation. However, existing instruments often lack sensitivity to cultural context and are not optimized for routine use by nurses in community settings. Objective: This study aimed to develop and test the initial validity and re-liability of a nurse-based Functional Recovery Scale for patients with schizophrenia in a community mental health setting.
METHODS: A pilot study with a quantitative design was conducted from June to August 2024 at an outpatient mental health facility in Yogyakarta, Indonesia. A total of 30 patients diagnosed with schizophrenia were selected through purposive sampling. The initial instrument consisted of 40 observational items across seven domains: physical, psycho-logical, social, economic, religious, medication adherence, and communication. Construct validity was assessed using Spearman’s correlation, while internal consistency was evaluated using Cronbach’s alpha.
RESULTS: Of the 40 items initially tested, 38 were found to be valid, with r values above 0.361 and p<0.05. Two items (“able to dress independently” and “able to eat independently”) were excluded due to low correlation values, likely because of ceiling effects. The scale demonstrated excellent internal consistency, with a Cronbach’s alpha of 0.977. The instrument effectively captured key aspects of functional recovery relevant to the Indonesian cultural context and nursing practice.
DISCUSSION AND CONCLUSION: The developed instrument demonstrated satisfactory validity and high internal consistency. The final 38-item scale, with its nurse-observed and culturally relevant design, may serve as a practical tool for assessing functional recovery in schizophrenia, particularly in Indonesian community care settings. However, given the small sample size (n=30) and single-site design, further studies with larger samples, multiple sites, and cross-validation against interna-tional instruments are recommended to enhance generalizability and establish inter-rater reliability. These findings suggest that nurse-observed, culturally grounded instruments may offer practical advantages over existing tools in community mental health settings, particularly in contexts where spirituality plays a central role in recovery.

Keywords: Functional recovery, nurse observation, reliability, schizophrenia, validity