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Effect of Psychoeducation
Jay A. Elmer Ivan M.
on Self-esteem and Self-efficacy
Ablog, RN, MN 1 Calaustro Jr., RN, MN 2
among College Students
Abstract

Authors suggest efforts are needed to further explore the usefulness and utilization of
Anthony Von Leo Miguel Oriel psychoeducation at the community and professional levels as applied to various
M. Cala 3 A. Carvajal 3
settings and populations. In addition, if developed and implemented carefully,
psychoeducational interventions have promising application on other life challenges
across levels of the public health, social, and educational systems. This quasi-
experimental three group pre-test post-test study aims to investigate the effect of
psychoeducation on the self-esteem and self-efficacy of college students. A total of
105 college students (35 subjects per group) who were enrolled at Saint Louis
Iris Yvonne T. Cerezo 3 Jomelle G. Eligio 3 University, Baguio City, Philippines were included as sample. Sampling technique
was purposive. The Rosenberg's Self-esteem Scale and Schwarzer's General Self-
efficacy Scale were used as data gathering tools. A self-made psychoeducational
module that was validated by experts in mental health and psychiatric nursing was
utilized as intervention. SPSS version 20 was used for the statistical analysis. The
results on the post-test scores of both treatment arms (informational and
comprehensive model) were significantly higher compared to control group after eight
Alexis Mae D. Estoesta 3 Monica S. Go 3
sessions of psychoeducation. The researchers therefore conclude that both psycho-
education models (informational and comprehensive) showed evidence of
effectiveness in increasing the self-esteem and self-efficacy levels of college
students.

Keywords: Psychoeducation, self-esteem, self-efficacy, comprehensive model, informational

model
Janna Vernette Prima Angelica
D. Orca 3 M. Piedad 3
Introduction

here is no health without mental health (World Health Organization, 2005).”

“T This statement depicts the growing emphasis on the importance of not only
having a healthy body, but also a healthy mind. It is therefore essential to
enhance not only the physical health of a person but the mental health as well.
Diomari Kathleen Christine Dianne
R. Romero 3 P. Tesoro 3 “Mental health is state of well-being in which every individual realizes his or her own
potential, can cope with the normal stresses of life, can work productively and fruitfully,
and is able to make a contribution to his or her community (World Health Organization,
2001)”. Several components comprise mental health. Among these components are
self-esteem and self-efficacy (Maddux, 2014).

1 Primary and Corresponding author; Faculty of Saint Louis University, School of Nursing; yaj_golva17@yahoo.com
2 Faculty of Saint Louis University, School of Nursing
Jenela May N. Tuguinay 3 3 BSN students at SLU-School of nursing (BSN III-D1 Batch 2017)
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Self-esteem is how people think and feel about themselves (Sasat psychoeducational approaches into a semester class under the
et al., 2002). Self-efficacy refers to a person's belief that he or she umbrella of effective stress management. The class integrates
is able to effectively perform the tasks needed to attain a valued physiological and psychological understandings of stress and
goal (Bandura, 1997). Once a person's self-esteem is in place, it stress management with evidence-based skills including
kindles further success. Likewise, a person with finely honed self- relaxation techniques, problem-solving, mindfulness, cognitive
efficacy will have a more goal oriented behavior with positive restructuring, and assertiveness. The course also included a set
outcomes, and a more stable self-regulation (Zimmerman & of skills consistent with the positive psychology literature on the
Timothy, 2006). The need to possess a high level of self-esteem development of resilience. An instructors guide, course slides,
and self-efficacy is crucial to succeed in most dimensions of life. In course syllabus, and recommendations for readings,
reality though, the number of mental health problems globally homework, and practices are provided. The current study
among the general population including the college students focuses on psychoeducation to improve self-esteem and self-
continue to increase in terms of severity and frequency efficacy. It will also explore what model of psychoeducation will
(Higginbotham, 2013). be effective for college students.

In the local setting, Saint Louis University, Baguio City, Philippines Psychoeducation is a systematic, didactic, psychotherapeutic
reported that there was an increase in the number of college intervention designed to inform clients and their relatives about
students who sought counseling service at the Guidance Center mental disorder and psychosocial problems and to promote
due to mental health problems and psychological issues. From the coping (Bhattacharjee et al, 2011). Types of psychoeducation
663 undergraduate students who sought counseling service in the include the information and comprehensive model. Information
academic year 2012-2013, the figure almost doubled in the model provides clients and families the knowledge about
academic year 2014-2015 (663 versus 1063). Latest statistical psychiatric illness and psychosocial problem and its
data shows that in the academic year 2015-2016, there were 1, management (Bhattacharjee et al, 2011). Comprehensive
235 college students who sought counseling. The report model, also called combination approach consists of
contained various concerns like family, personal affairs, information, skill training and supportive approach through
academics, relationship, future, and other concerns. In addition, individual sessions (Bhattacharjee et al, 2011).
the report from the guidance center also shows that under
personal concerns, issues like low self-esteem and low motivation To date, psychoeducation addressing schizophrenia and cancer
are included as reasons for seeking professional help at the can be considered evidence based (Ozkan, Erdem, Ozsoy &
Guidance Center (Saint Louis University Guidance Center, 2016) Zararzis, 2013; Xia, Merinder & Belgamwar, 2011), and some
authors (Lukens & McFarlane, 2004; Dixon et al., 2001) suggest
To improve self- esteem and self-efficacy, several interventions a need for more extensive studies of psychoeducation in order to
have been identified to be effective like cognitive behavioral establish its usefulness in the management of psychosocial
therapy, counseling, physical activity intervention, and group problems.
therapy.
The increase in the number of students having low self-esteem
Lukens and McFarlane (2004) discuss that one of the most and low self-efficacy and its negative effects cannot be ignored.
effective evidence-based practices that have emerged in both Today, there is also growing emphasis on the utilization of cost-
clinical trials and community settings is psychoeducation. The effective intervention like psychoeducation on improving mental
flexibility of the psychoeducation, which incorporates both health. There is also a need to try and test creative strategy like
illness–specific information and tools for managing related psychoeducation. In addition, the interest of the researchers in
circumstances has a broad potential for many forms of illnesses mental health and adolescent psychiatry, the advocacy to
and varied life challenges. Patient education or psychoeducation promote mental health among adolescents gave the
is an important independent function of the nursing profession researchers the impetus to conduct the study.
(Spellbring, 1991) and historically been in the domain of nursing
(Sanford, 2000). Although most psychoeducation programs are The aim of this study is to investigate the effect of 8 session
implemented in hospital and community based settings, psychoeducation on the self-esteem and self-efficacy levels of
Cartwright (2007) proposes that the school system is another college students. The researchers aim to answer the following
potential venue for developing psychoeducation interventions. research questions: 1.) Is there a significant effect on the college
student's self-esteem level and self-efficacy level after the
To address the increasing number of mental problems and introduction of psychoeducational intervention?; 2.) Is there a
growing need for mental health services among college students, significant difference on the self-esteem level and self-efficacy
Higginbotham (2013) explored the utilization of psychoeducation level between groups-Control Group, Informational Group and
to improve college students' mental health. He combined proven Comprehensive Group?
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Ausubel's Assimilation Theory, Albert Ellis' Cognitive Behavioral can secure them innumerable personal and social benefits. The
Theory and concepts from Albert Bandura's Social Cognitive ability to affect outcomes makes them predictable. Predictability
Theory were used as the conceptual framework of this study. fosters adoptive preparedness. Inability to exert influence over
things that adversely that affect one's life breeds apprehension,
Learning occurs through development of new cognitive apathy, or despair” (Bandura, 1997)
structures that will hold newly acquired information. Cognitive
structure is defined as the “individual's organization, stability, and In this study, the students appraised their own capability to
clarity of knowledge in a particular subject matter field at any accomplish and now know that they can make a difference. The
given time'. When there is new knowledge, it is linked to an cognitive structure of an individual is programmable, which can be
existing general concept. In this study, psychoeducation was programed in such a way that individual will perceive the task to be
facilitated by researchers in order to enhance the cognitive accomplished will be achievable. The researchers applied
structure of the subjects. The psychoeducation focused on topics psychoeducation by teaching the participants concepts and skill
about self-esteem and self-efficacy to generate or impart new on improving self-efficacy. Therefore, the researchers utilized
knowledge and skills to the participants. Since the participants psychoeducation to increase the students' self-efficacy and
have experiences of low self-esteem and low self-efficacy levels, resulting to the students to be more convinced that they can
they will be able to relate it with the new knowledge they have accomplish an activity.
acquired. This new knowledge was anchored in their cognitive
structure, applied and resulted to improved self-esteem and self- The study will promote a cost-effective psychotherapeutic
efficacy levels. intervention that would help students or clients improve their self-
esteem and self-efficacy. Psychoeducation can be used as stand-
Albert Ellis developed an ABC format to teach people how their alone or adjunct intervention to improve self-esteem and self-
beliefs cause their emotional and behavioral responses: 'A' efficacy. The study will also provide an opportunity for the
stands for activating event or adversity. 'B' refers to one's participants to verbalize their thoughts and feelings with regards
irrational belief about 'A'. That belief then leads to 'C,' the to their selves. Furthermore, the participants will be able to learn
emotional and behavioral consequences. Ellis believes that it is and apply psychoeducation to improve their self-esteem and self-
not the activating event (A) that causes negative emotional and efficacy. The researchers will also benefit since this study will
behavioral consequences (C), but rather that a person interpret provide an opportunity to enhance their skills in delivering
these events unrealistically and therefore has irrational belief psychotherapeutic interventions specifically psychoeducation.
system (B) that helps cause the consequences ©. Since proven effective, the researchers could also utilize
psychoeducation to improve their self-esteem and self-efficacy.
In the study, the students developed irrational beliefs or negative The school administrators will also be updated about this cost-
thoughts about themselves. Through psychoeducation, the effective intervention and this study can be a basis for developing
researchers taught the students about information and skills to mental health programs and activities for students specifically
improve self-esteem and self-efficacy. Thus, with the aid of targeting mental health promotion. Part of this study is the creation
psychoeducation, the participants were able to change their of module on developing self-esteem and self-efficacy. The
personally identified irrational beliefs about themselves into
module can also be used by faculty members who are teaching
positive beliefs, leading to improvement in their self-esteem and
psychiatric nursing and supervising students in psychosocial
self-efficacy.
counseling. The findings of the study can also contribute to the
This study is also grounded on Albert Bandura's Social Cognitive existing body of knowledge on psychoeducational intervention
Theory. In this theory, he describes that an important aspect of and be a springboard for other research related to
the self is self-efficacy. Self-efficacy refers to the feelings of psychoeducation.
adequacy, efficiency, and competence in coping with life. Meeting
and maintaining the performance standards enhances an Methodology
individual's self-efficacy, while failure to meet and maintain those
standards reduces the self-efficacy. Bandura also describes self- The study utilized a quasi-experimental design. The researchers
efficacy in terms of the perception of the degree of control over believed that this is the most fitting design for the study since the
one's life: researchers are interested in the effects of psychoeducation on
the self-esteem and self-efficacy of college students. The study
“People strive to exercise control over events that affect their consisted of a control group and two treatment groups. The
lives. By exerting influence in spheres over which they command control did not receive psychoeducational intervention.
some control, they are better able to realize desired futures and to Randomization of subject was not done. Baseline self-esteem
forestall undesired ones. The striving for control over life and self-efficacy scores were initially measured using standardize
circumstances permeates almost anything people do because it tools and post-test was done after a month or eight sessions of
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psychoeducation. The study was approved by SLU Research secondary uses of the module. It is also divided into sections
Ethics Committee with protocol number: SLU-REC 2016-006. (psycho-information and psycho-skills). Topics in the module
include definition and development of self-esteem and self-
A total of 105 college students (35 subjects per group) who were efficacy. Discussion on how to measure self-esteem and self-
enrolled 2nd semester of the academic year 2015-2016 at the efficacy was also included. In addition, the effects of low self-
different undergraduate schools of Saint Louis University were the esteem, effects of having a well define self-efficacy, and ways or
subjects of this study. The sample size was computed using the tips on how to improve self-esteem and self-efficacy were also
Yamane's formula and sampling technique was purposive- included in the module. For the psycho-skills part of the module,
homogenous sampling. The following study criteria were also met the researchers included some evidence-based interventions
by the participants: ages between 15-19, willing and committed to and activities to enhance self-esteem and self-efficacy. These
participate in the study or psychoeducation intervention, able to activities include cognitive re-structuring, positive self-talk, and
understand and communicate in English and have baseline self- self-reflection or self-analysis. Worksheets and assignments
esteem score of 18 and below. Students from the school of were also provided.
medicine, law and graduate programs, married, pregnant or have
small child or children, students with major psychological In this study, there was a control group and two treatment
disorders or have other mitigating medical conditions which will groups. The control group did not receive any intervention. Pre-
impede them from participating in the psychoeducation were test measure of self-esteem and self-efficacy of subjects was
excluded in the study. The researchers utilized vacant rooms and done at the start of the study and was re-assessed after one
the psychosocial counseling room located at the Nursing faculty month. Informational model group (Treatment A) and
room at Diego Silang Building for the psychoeducational Comprehensive model group (Treatment B) underwent eight
intervention. sessions of psychoeducation on self-esteem and self-efficacy.
Specifically, the Informational Group (Treatment A) were given a
For students who are 18-19 years old, the researchers took their module on psychoeducation for them to read during their free
consent or let the student sign the consent form after explaining it. time for a period of one month. The Comprehensive group
A copy of the consent form was also given to the subjects. For (Treatment B) was closely supervised by the researchers and
participants 18 years old and below (15-17), the researchers let underwent a comprehensive approach of psychoeducation-
the students signed the assent form and let the parents signed the combination of information dissemination, skills training, and
informed consent form for parents. supportive approach. Activities in the pyschoeducation for both
groups were structured using a psychoeducational plan.
Self-esteem of college students (pre-test and post-test) were
measured using the Rosenberg's self-esteem scale while self- All throughout the study the researchers maintained the
efficacy levels were measured using the Generalized Self Efficacy anonymity, autonomy and confidentiality of data. If in any event a
Scale (GSES). Rosenberg's self-esteem scale is a 10-item scale subject from the control group and the informational group is
that measures global self-worth by measuring both positive and interested to undergo the comprehensive psychoeducation
negative feelings about the self. All items are answered using a 4- intervention, the subjects were instructed that their request will
point Likert scale format ranging from strongly agree to strongly be granted after the study.
disagree. On the other hand, Generalized Self Efficacy Scale
(GSES) is also ten-item scale that assesses the effectiveness of Moreover, the student researchers underwent a series of
an individual's belief in his or her own ability to respond to novel or orientations and skills training on psychoeducation and
difficult situation and to deal with any associated obstacle. Both psychosocial processing facilitated by their research promoters
tools are valid with Cronbach's alpha coefficients ranging from to ensure equivalence. All members of the research team
0.72 to 0.87 and 0.76 to 0.90 respectively including the research promoters had a series of dry run of the
experimental protocols to ensure uniformity of procedures in
Self-made psychoeducation module on enhancing self-esteem administering the psychoeducational intervention and
and self-efficacy were given to the subjects of the study. The administration of questionnaire. The researchers also
module was subjected to face and content validity of experts in developed a facilitator's manual for the psychoeducational
mental health and psychiatric nursing and research prior to use of module to ensure uniformity of using the module in the
these materials. The comments and suggestions of the experts comprehensive group. Furthermore, the same research
were used to improve the module. members followed up the same subjects throughout the study.

The module on enhancing self-esteem and self-efficacy is a 41 Statistical results were computed using SPSS version 20. Mean
page soft bound module printed in a standard size paper. The scores and p-value was used to present the results. Parametric
preliminary pages contain the description, objectives, primary and statistics like T-test (paired two sample for means) was used to
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Table 1. Effect of psychoeducation in improving the self-esteem and self-efficacy of the subjects (n=105)

determine the significant effect of psychoeducation on the self- have a relation with the theory of Albert Ellis. The participants
esteem and self-efficacy of college students in the control and were allowed to vent their concerns about themselves and was
treatment groups. Independent T- test was used to determine the processed through the application of the concepts and different
significant effect of psychoeducation on the self-esteem and self- exercises or activities found on the module, allowing them to
efficacy of college students in the control and treatment groups. change their negative perception about their selves. Therefore,
psychoeducation with a counselor or a peer teacher allowed the
Results and Discussion participants to have an insight on what causes them to have low
self-esteem and explore ways or strategies to increase their self-
Effect of psychoeducation in increasing the self-esteem of esteem.
college students: Table 1 shows the summary of the paired t-test
that evaluates the significant effect of psychoeducation in Informational model is done by imparting information to increase
increasing the self-esteem of college students. The analysis of the awareness of the persons involved about a specific condition
pretest and post-test mean scores of both treatment groups, (Bhatacharjee, et.al. 2011). Thirty two out of thirty five students
comprehensive and informational group showed that the self- have an increase of self-esteem after introduction of
esteem mean values (15.26 vs 22.94; 15.49 vs 21.11) of college psychoeducation. The psychoeducation focused on topics about
students increased after the introduction of psychoeducation. self-esteem to generate or impart new knowledge and skills to the
respondents thru reading. Since the respondents have
The comprehensive group received one-on-one or peer-to-peer experiences of low self-esteem, they were able to relate it with the
interactions, the students were able to observe and learn from new knowledge they have acquired. This new knowledge was
other people in a controlled therapeutic environment (Sayder, anchored in their cognitive structure, applied and resulted to
2008). Almost all (34 out of 35) participants have an increase self- improved self-esteem levels.
esteem after the psychoeducation. It was proven that
psychoeducation when done with a counselor or peer teacher The results also show that psychoeducation, whether
(such as in the comprehensive model group) was effective in comprehensive or informational model, have significant effect on
increasing the self-esteem of students. This finding was improving self-efficacy. The analysis of pretest and post-test
supported by the study of Menezes, Burgess, Clarke, and Mellis mean scores of both comprehensive and informational group
(2016) which elucidate that peer learning program have been showed that the self-efficacy scores (26.20 vs 32.40; 28.14 vs
effective in gaining practical skills and valuable learning. 31.83) of the college students increased after introduction of
Moreover, active learning was more preferred because it caused psychoeducation intervention. The results showed that the
them to gain clarity on the topic, arousing intellectual curiosity, comprehensive group had a higher increase compared to the
promoting student interaction and yielding a more effective informational group although the both of them were statistically
learning, subsequently increasing their self-esteem. the same. Majority of the participants (31 out of 35) in the
comprehensive model group had an increase in self-efficacy
Feedback was also assessed at the last session of the study and level. This result show that with the regular interaction between
participants verbalized that they are satisfied with the the therapist and the client can lead to a definite increase in the
intervention. The students further stated that the study helped self-efficacy of an individual. Generally, students with increase in
them change their negative self-perceptions. This claim may self-esteem scores had also increase self-efficacy scores.
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The studies conducted by McCoach, (2007) and Shorey, Chan, Additionally, the results revealed that the intervention, whether
Seng, & Hong-Gu, (2015), in summary, elucidate that informational or comprehensive, is effective in increasing the
psychoeducation given in the form of mentoring, teaching and self-efficacy of college students. The study of Shimazu,
supervised learning would most likely cause the client to have an Kawakami, Irimajiri, Sakamoto, Amano, (2005) revealed that the
increase in self-efficacy. Maddux and Kleinman (2014) posit that intervention they used, which was psychoeducation, increased
self-esteem greatly influence the self-efficacy because how you the self-efficacy of their participants, especially in willingness to
feel about yourself overall greatly influence your confidence in exert effort in completing the behaviors and persistence in the
your ability to perform well in activities. As for the informational face of adversity. The result suggested that the intervention was
group, 28 out of 35 participants have an increased self-efficacy. indeed effective, and most importantly, these increases can be
The studies of Shimazu, Kawakami, Irimajiri, Sakamoto, Amano, achieved during a short period of time with minor changes in
(2005) and Santoso, Lawanto, Becker, Fang, & Reeve (2014) instructional style.
state that having the client receive a module or self-help treatment
could also lead in the increase of self-efficacy or change of This study implies that with the help of psychoeducation whether
behavior. with module alone or done the help of a counselor or a peer
teacher, self-esteem and self-efficacy of individuals can
Effect of psychoeducation in improving the self-esteem and self increase. Psychological problems that lead to low self-esteem
–efficacy. Table 2 consists of the summary of the independent- and self-efficacy can now be addressed with the use of this
samples t-test to determine the significant differences of two psychotherapeutic intervention. This kind of self-help treatment
groups at a time using the post-test scores. Statistically, can and will also educate any reader on ways to cope with the
informational model and comprehensive model of stressors of life. Psychotherapeutic interventions like these will
psychoeducation are the same in terms of increasing the self- help not only individuals who are experiencing psychological
esteem and self-efficacy levels. The result shows that both models problems but can also be used by individuals to maintain or
of psychoeducation are effective improving self-esteem and self- increase their self-confidence. This research can also be a basis
efficacy of college students. of mental health programs in the schools and the
Table 2. Difference in the Effect of Psychoeducation in
psychoeducational module can also be used by faculty
members and counselors
Improving the Self-esteem
and Self -Efficacy of the Subjects (n= 105)
Limitations
Groups Compared Self-esteem Self-efficacy
In summary, psychoeducation is an effective intervention in
Control Group & Treatment A <0.0001 0.006 improving the self-esteem and self-efficacy of college students.
Several uncontrollable factors may contribute to the outcome of
Control Group & Treatment B <0.0001 0.001 this study. Example, the time and place in which the
Treatment A& Treatment B 0.057 0.435
psychoeducation was administered in this study was not
controlled especially in the informational model since the study
was performed with its intent being self-directed. The only
Treatment A received the informational model, which had received control we had as a research team was the reminders via call or
the module and are considered self-learners. Informational private message in phone or Facebook to read the module.
modules provide an effective environment for learning (Dhamija & There is a lack of control to other stimuli such as varied defense
Kanchan, 2014). This allows the student to learn on their own. By mechanisms, characteristics of the subjects, and life situation,
learning, they change their cognitive structure, and replace their daily stress of the participants which may have had an effect on
old knowledge with the new one (Ausubel, 2000). If self-esteem is the results. The module used in this study was only validated by
enhanced, an increase in self-efficacy subsequently follows two experts. Qualitative comments on how to improve the
(Maddux, 2014). Comprehensive model is effective as well. In the module were carried out however the content validity index was
research, the treatment B group had an interactive approach with not measured using a tool. The sample size is small for the
the researcher and gained higher scores on the post test results. findings to be generalized since sample size was computed at
Moreover, active learning was more preferred by students 10% margin of error. Another limitation is the sampling technique
because it caused them to gain clarity on the topic, arousing which is purposive. The findings might not be generalizable
intellectual curiosity, and promoting student interaction and among college students. Despite these limitations it can be
yielding effective learning. argued that this initial study showed promising results.
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Conclusion and Recommendations Dixon, L., McFarlane, W., Lefley, H., Lucksted, A., Cohen, M., Falloon, I.,
et al. (2003). Evidence-based Practices to Families of People with
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“
among workers: A Controlled Clinical Trial. J Occup
Health, 47, 405-413 When I think about
Shorey, S., Chan, S., Seng, C., Hong-gu, H., (2015). The
effectiveness of a postnatal psychoeducation program on all the patients and their
self-efficacy, social support and postnatal depression among
promiparas: A randomised controlled trial. J Adv Nurs, 71(1),
193-203. doi: 10.1111/jan.12461 loved ones that I have
Spellbring, A.M. (1991). Nursing role in health promotion. An
overview. Nursing clinics of North America, 26 (4), December worked with over
1991: 805-813World Health Organization (2001).
Strengthening mental health promotion. Fact Sheet No. 220, the years, I know
Geneva.
World Health Organization (2005). Mental health: facing the
challenges, building solutions. Report from the WHO
most of them don't
European Ministerial Conference. Copenhagen Denmark:
WHO Regional Office for Europe. remember me nor I them,

About the Authors

BUT I DO KNOW
Jay Ablog, RN, MN, is a faculty and a research
THAT I GAVE
promoter at Saint Louis University-School of Nursing,
Baguio City. He hold a master’s degree in nursing A LITTLE PIECE
specializing in Mental Health and Psychiatric Nursing.
He is also PhD candidate currently writing his
dissertation. His research interest include mental health OF MYSELF
promotion activities or psychotherapeutic interventions,
adolescent psychiatry, depression and suicide. TO EACH OF THEM
Elmer Ivan M. Calaustro Jr., RN, MN, is a faculty and a
research promoter at Saint Louis University-School of
Nursing, Baguio City. He hold a master’s degree in and they to me and those threads
nursing specializing in Mental Health and Psychiatric
Nursing. His research interest include mental health and
psychiatric nursing.
make up the beautiful tapestry
Acknowledgement: The authors would like to in my mind that is my career
acknowledge Ms. Rufina C. Abul and Dr. Teresa N.

”
Basatan for validating their psychoeducation module. in nursing.

- Donna Wilk Cardillo