A mini thesis submitted in partial fulfilment of the requirements for the degree of Magister Curationis in Psychiatry, University of the Western Cape.
Within South Africa there is a growing need for qualified Professional Nurses, as mental health nursing has consistently emerged as an unpopular career choice within the comprehensive nursing program (R425). Nurses that have completed the R425 program report fear, mistrust, and dislike of the mentally ill as reasons for not pursuing a career in mental health nursing. As such, the nursing profession struggles to attract graduates into this discipline. Professional nurses with additional training in mental health report attitudes and perceptions of mental health nursing that are more positive, whilst those with less training report more negative attitudes and perceptions to mental health nursing. Moreover, inexperience, insufficient skill, and lack of knowledge in mental health nursing-, also affects the nursing care provided to the mental health care user. Mainstreaming mental health nursing within the adopted Primary Health Care framework in South Africa is plagued by many challenges as professional nurses play a significant role in both the care and rehabilitation of the mentally ill. The primary aim of this research study was to describe the attitudes and perceptions of professional nurses towards the mentally ill. The objectives of this study were: to explore the attitudes and perceptions of professional nurses towards the mentally ill; to identify the most common factors that influence the professional nurses attitudes and perceptions towards the mentally ill; to compare the attitudes and perceptions of professional nurses towards mental illness between professional nurses who have completed the R425, R808 and R212 training in mental health nursing. A quantitative, exploratory, descriptive design was employed. A cross-sectional survey was carried out.
Participants comprised of all permanent and agency professional nurses working at Stikland hospital (n=60), a governmental Associated Psychiatric Hospital in the Cape Metropole. Participants completed a demographic questionnaire and two self-report questionnaires, namely, Attitude Scale for Mental Illness and the Mental Health Problems Perceptions Questionnaire. The Senate Research Committee of the University of the Western Cape granted permission for this study. Permission was granted from Stikland hospital to conduct the research.
I, the undersigned, declare that Professional Nurses’ Attitudes and Perceptions towards the mentally ill in an Associated Psychiatric Hospital, is my own work, that it has not been submitted for any degrees or examination at any other university, and that all the sources, or quotes I have used, have been indicated and acknowledged by complete references.
The mainstreaming of mental health nursing as well as the increased rate of mental illness has impacted on nurses working in both general hospitals and mental health care facilities. That said, the requirements for care by nurses in the aforementioned settings have increased. Reed and Fitzgerald (2005) found that nurses in Australia have less access to education, support and mental health services. These aforementioned factors appear to influence the attitudes of Professional Nurses (PN’s) and subsequently the care of mentally ill clients. The diverse attitudes of PN’s and their capability to provide high-quality care are reflected in the standard of their education, mental health nursing experience and support received. PN’s with little or no training in mental health nursing showed fear and avoidance behaviour with regard to working with the mentally ill, in comparison with those nurses with training in advanced mental health nursing, who showed more comfort and enthusiasm for mental health nursing (Reed& Fitzgerald, 2005).
Less educated PN’s in general hospitals in South Africa (SA) displayed negative attitudes towards the mentally ill due to the increased demand and growth of mental health services (Mavundla, Poggenpoel & Gmeiner, 2001). Lethoba, Netswera & Rankhumise (2006), found that in experience, insufficient skills and lack of knowledge in the mental health field affected nursing care provided to the mental health care user (MHCU).
Mental health care in SA is currently supported by policy changes as well as new legislation (Moosa& Jeenah, 2008).
The delivery and organization of MHC in post-apartheid SA is undergoing major changes (Lund& Flisher, 2001).
One such legislation is the Mental Health Care Act (MHCA), 17 of 2002, which requires that mental health service delivery adopt a primary health care approach, with an emphasis on community care (Moosa, 2008). Despite the Declaration Alma Ata in 1978, in South Africa the right to health services, especially mental health services, remains unrealized for many people of low income, rural-based and resource-poor areas. Although the Western Cape has developed a Community-Based Service Policy Framework as well as a Service Delivery Plan, their services are fragmented according to the vertical health programs. Both these abovementioned service providers resulted in fragmented line management, from lack of planning regarding Community Based Health Services (CBHS). According to the World Health Organization (WHO), the integration of mental health services into primary health care is the most practical way of ensuring that people have access to mental health services and the care they need. Accessibility of mental health services is then closer to their home, thus keeping families together and maintaining their activities of daily living. Consequently, the client avoids the indirect costs associated with seeking specialist care in distant locations (SA Federation for Mental Health, 2009). The progress of the integration of mental health services into the primary health care system in South Africa is insufficient. Continuous training and support is needed for primary mental health care workers to ensure that integration occurs. According to the WHO (2007), health professionals are very scarce in developing countries. PN’s need to be trained and provided with proper guidelines on the principles of basic mental health care (Moosa & Jeenah, 2008).
The MHCA has been amended numerous times. Both the amended Health Act 63 of 1977 and the National health Plan for South Africa formulated a policy shift from a curative orientation to a comprehensive health care service. The South African Nursing Council (SANC)’s regulation R2598 of November 1984 required that registered nurses practice under the Nursing Act 50 of 1978.As such, the SANC introduced a four-year nursing course, Regulation R425 of 22 February 1985. In 1986, the South African government acknowledged a need for comprehensive health care services for the South African population. According to Hlongwa (2003), R425 graduates perceived themselves to be incompetent in the following: designing and implementing rehabilitation programmes and/or workshops, managing community projects, conducting research and managing crises in psychiatric nursing units (Hlongwa, 2003).
This previously mentioned MHCA, 17 of 2002, has broadened the mental health nursing terminology currently used in the field. For example, the term ‘mental health nursing’ (MHN) has to a certain degree replaced the term ‘psychiatric nursing’. Seeing that, MHN is synonymous with psychiatric nursing, psychiatric nursing will be referred to as MHN in this.
Given the aforesaid, it is of importance to investigate the opinions and attitudes of PN’s to mental illness.
1.2 Problem Statement
Mental illness is increasing in SA (Govender, 2006). Social stigma and negative attitudes can affect the quality of life of people with mental illness (Corrigan, Green, Lundin, Kubiak, & Penn, 2001). PN’swith less training in mental health has reported negative attitudes and perceptions towards mental health nursing (Reed & Fitzgerald, 2005). Whilst PN’s with additional training in mental health, such as the R880,who have completed a three-year diploma in psychiatric nursing and R212, who has completed a one year course in clinical psychiatry, generally have reported positive attitudes and perceptions towards mental health nursing (Reed & Fitzgerald, 2005). Based on both the literature review and the clinical experience of the researcher, the following research question has been identified “does the level of mental health training (i.e. either R425/R880/R212) of nurses, influence their attitudes and perceptions towardsthe mentally ill?”
1.3 Significance of the Study
The significance of this study is that it would document the attitudes and perceptions PN’s have towards the mentally ill in a mental health institution in the Cape Metropole. Furthermore, it would establish whether there is a relationship between education, experience and the outcome of positive versus negative attitudes towards the mentally ill. This study will make the Department of Health and the authorities aware of the different attitudes of PN are which are influenced by work experience and level of education. In addition, it should create an awareness of the shortcomings of PN’s at Stikland hospital. The findings should facilitate future planning of additional education and if needed, in-service training which could be rendered to PN’s who express the need.
1.4Research Aim and Objectives
1.4.1 Main Objective:
The primary aim of this research study was to describe the attitudes and perceptions of PN’s towards the mentally ill.
1.4.2 Specific Objectives
The objectives of this study were as follows:
1. To identify the attitude of nurses towards the mentally ill.
2. To identify factors which influence the attitudes and perceptions of nurses’ towards the mentally ill.
3. To compare the attitudes and perceptions of PN’s, who have completed the R425, R808 and R212 training in mental health, towards the mentally ill.
4. To determine whether any differences exist in the attitudes and perceptions of PN’s in terms of different training programmes.
1.5 Ethical Considerations
Graziano and Raulin (2004) found that in order to maintain high standards of research, the conducting of research not only requires expertise and , but also honesty and integrity. In addition, ethical research is essential to generate sound knowledge for practice.
According to De Vos (2001), ethical guidelines serve as a basis upon which a researcher can evaluate his or her conduct. Furthermore, a researcher needs to carefully consider the ethical requirements of research during the planning phase. Ethical considerations are vital to any study, because of the influence of the researcher’s ability to acquire and retain participants.
The researcher’s proposal was sent for approval to the Research and Ethics Committee at the University of the Western Cape.
Literature review/Theoretical framework
This chapter contains a discussion ornamental health nursing as a speciality, as well as quality of care is influenced by certain factors. Education, training and experience influence the attitudes of PN’s which are positive, negative or indifferent. All of the abovementioned can be supported by the theory of attitude.
2.2 Mental Health Nursing as a speciality
Mental health nursing is a specialised field within the nursing profession. The mainstreaming of mental health care, as well as the increased rate of mental illness, has impacted on nurses’ working in both general hospitals and mental health care facilities (Mavundla et al., 2001). Furthermore, in 2001 it was reported that there is less than one psychiatrist and mental health nurse per 100 000 people in SA and, in more than half of the countries globally . The majority of patients as well as their families who are looking for assistance and support for their mental illness legally expect the hospital along with the nursing staff to be aware of their needs and treat them as unique individuals, devoid of any prejudice and discrimination . Working as PN’s may cause a considerable amount of stress because of both emotional exhaustion and work overload.
PN’s in general hospitals with less education and training in mental health in SA displayed negative attitudes towards the mentally ill due to the increased demand and growth of mental health services (Mavundla, et al., 2001). Lethoba et al, (2006) found that inexperience, insufficient skills, and lack of knowledge of mental health affected nursing care provided to the mental health care user (MHCU).
2.3 Theory of Attitude
Attitudes are learned through the process of social learning; this is learning from the social environment. When inexperienced PN’s in the mental health field are constantly taught about the violent behaviour and danger of mentally ill patients, an attitude will be formed. Attitude is formed on the information given to PN’s prior to any exposure to the mentally ill (Jackson & Francis, 2004). According to Pagel and Davidson (1984), any human beings’ moral values play a main part to influence their attitude towards anything. The more exposure an individual has of the social world, the more knowledge he or she gains and this familiarity will help to create an attitude. The more encounters that a person has with an entity the more they can produce positive attitudes .
2.4 Factors Influencing the Quality of Mental Health Care.
The attitudes of PN’s as well as their capability to provide high-quality care is influenced and reflected by a number of factors, namely, the standard of their education, mental health experience and the work support they receive. It has been argued that the attitudes and knowledge of health professionals towards mental illness is a major determinant of the quality and outcome of care for the mentally ill . PN’s are responsible for ensuring that patients with severe mental illness receive the services they need in a timely manner. Furthermore, PN’s need to be knowledgeable to provide mental health education along with care with a positive attitude in the community, as community care is the most accessible form of care worldwide (World Health Organization, 2007). Reed and Fitzgerald (2005) found that PN’s with little or no training in mental health showed fear and avoidance behaviour in relation to working with the mentally ill, in comparison with nurses who had received advanced mental health training.
In the apartheid era, government lacked a coherent PHC strategy. The health system was biased towards curative services with only 11% of total public sector health care expenditure devoted to non-hospital primary care services. Primary mental health care workers need to be trained and provided with proper guidelines on the principles of basic mental health care (Moosa & Jeenah, 2008). Currently, ‘Community psychiatric nurses now focus their attentions almost entirely on people with serious and enduring mental illnesses and undertake case management roles in community teams ‘(Gournay, 2005, p.6).
PN’s need to both be trained and provided with proper guidelines with regard to principles of basic mental health care (Moosa&Jeenah, 2008).
According toCorrigan & Watson, (2004), separatism was described to treat patients with mental illnesses in an institution rather than at home within the community. Separatism is a factor that is measuring PN’s attitude of discrimination towards the mentally ill (Akeret al., 2007).
Stereotyping is described as “the selective perceptions that place people to obscure differences within groups” (Aker et al., 2007). Corrigan & Watson (2004) describes stereotyping as the collective beliefs about different members of social groups, which lead to strong impressions, and expectations of individuals. The degree of nurses’ maintenance of social distance towards the mentally ill is measured by this stereotyping factor (Aker et al., 2007).
Restrictiveness refers to the amount of restriction the mentally ill patients experience during out-patient treatment as well as in-patient treatment. In addition after discharge how is society and their family protected from them. This factor was intended to measure “viewing the mentally ill as a threat to society”.
According to Hinkelman and Granello (2003) benevolence was described as “a paternalistic, sympathetic view, based on humanistic and religious principles”. Paternalistic behaviour can be summarised as being over-protective, affectionate, and warm towards the mentally ill. Caring, spirituality and compassion towards mentally ill patients and their illness are diverse attitudes that arise from a moral point of view within a person (Aker et al., 2007).
The sympathetic and paternalistic views of PN’s were measured by the benevolence factor.
2.4.5 Pessimistic Prediction
Pessimistic prediction, a negative evaluative component, is an aspect that measured the level of prejudice of PN’s towards the mentally ill along with their mental illness (Aker et al., 2007).
According to Mohale (2009) mental health professionals in the past, as well as currently, face a number of factors such as cultural beliefs, stigmatization as well as myths which threaten to derail the successful implementation of efficient mental health care in the community.
In the past as well as currently, clients with an intellectual disability or mental illness are isolated because of misconceptions and myths regarding mental illness. The stigma attached to mental illness is one of the greatest obstacles interfering with the quality of life improvement of clients and their families. The broader the evaluations regarding the previous year’s campaign of the mental health sector, it was evident that stigma is the most serious challenge that confronts clients with mental illnesses in their communities. The increasing incidence of mental illness is creating a huge challenge in the mental health society (SA Federation for Mental Health, 2009).
Poor knowledge, negative attitudes towards mental illness and poor understanding of mental illness by the public threatens the effectiveness of patient care and rehabilitation .Stigmatization is the sense of disgrace or discredit, which sets a people apart from one another. Discriminatory behavior of PN’s towards mental illness is measured by this specific factor (Aker et al., 2007).
2.4.7 Therapeutic Commitment
Effective interpersonal characteristics such as warmth and empathy are important for PN’s to adopt in support of their mentally ill patient. Thus, it is anticipated that the keenness and capability to make use of these therapeutic qualities is a utility of therapeutic commitment. In addition, therapeutic commitment is predisposed by PN’s’ self-perceived role competency along with role support in the work environment. During therapeutic commitment in the work area, assured core helper responses from the PN are essential and satisfactory for patients’ growth in mental health. Responses include the PN’s attitude towards the patient, mannerisms, as well as empathetic understanding towards the patient. Mentally ill patients become practiced to transform when the PN converse absolute devotion, honesty, and the patient’s current feelings. When patients feel safe in a PN-patient relationship, patients can start developing a trusting rapport. The faith of mentally ill patients depends on comprehensible dedication on the part of the PN in working therapeutically with the mentally ill patient. Therefore, if PN’s exhibited elevated levels of therapeutic commitment, they lessen the patient’s feelings of insecurity plus successful psychotherapeutic outcomes are more likely .
2.4.8 Role Support
PN’s who continuously receive support throughout their career, according to Reed & Fitzgerald (2005), portray increased comfort and more positive attitudes towards the mentally ill. According to Pace (2009) a study conducted in New Zealand, on how PN’s working as mental health support workers perceive their role. Findings concluded that PN’s felt the need of trust to have a meaningful and effective work relationship. Therapeutic relationships are viewed as meaningful and effective which is equally supportive and goal-orientated. Role support is defined as the apparent level of contact, as well as access or potential contact and access; one has to specialist mental health workers (Lauderet al., 2000).
When lack of teamwork exists within a mental health setting, the safety of the PN’s is a concern. Hefty amounts of work, little physical safety with security plus high ratios of patients-to-PN’s all add to decreased levels of sufficient patient care .
2.4.9 Role Competency
Role competency is having the required talent, knowledge, along with understanding of whether patients with a particular mental illness fall within one’s area of responsibility (Lauder et al., 2000).
2.5 Training/Educational programmes for Professional Nurses
Mental health nursing comprises two levels of expertise, namely basic and advanced. A mental health nurse with basic-level training is concerned with assessing the mental health needs of individuals, groups, communities and families, as well as developing a nursing diagnosis along with a care plan of how to care for these clients (Buchanan, 2009). Within this specific mental health nursing scope the nursing care plan and evaluation of the level of nursing care that the client should receive or is currently receiving, should be implemented. Additionally, a basic-level mental health nurse is more concerned with clients’ self-care and the monitoring of psychobiologic treatment. Furthermore, a basic-level nurse is trained to assist in both crisis counselling and the implementation of suitable client intervention (Buchanan, 2009). However, it is important to keep in mind that numerous factors play a role in shaping and influencing the attitudes and perceptions of PN’s towards mental health nursing. Attitudes were found to be linked to issues such as fear, causing avoidance, that influence PN’s ability to provide care. . Advanced mental health nurses provide a full range of primary mental health care services in addition to serving as educators, case managers, administrators and consultants (Buchanan, 2009).
Both the Health Act 63 of 1977 and the National Health Plan for South Africa formulated a policy shift from a curative orientation to a comprehensive health care service. As such, the legislation regulation of mental health nursing has been amended numerous times. SANC’s regulation R2598 of November 1984 required that registered nurses practice under the Nursing Act 50 of 1978. In this program, students were exposed to psychiatry over a two-year period. The R880 program is a three-year diploma in psychiatric nursing where student will have 3160 hours of psychiatric training. The R212 is a one academic year and the nursing course consists of 44 hours of training in clinical psychiatry.
In 1986, the SA government acknowledged a need for comprehensive health care services for the SA population. Subsequently, the SANC introduced a four-year nursing course, Regulation R425 of 22 February 1985.
According to Hlongwa (2003), R425 graduates perceived themselves to be incompetent in the following areas: designing and implementing rehabilitation programmes and/or workshops, managing community projects, conducting research and managing crises in psychiatric nursing units (Hlongwa, 2003).
2.6 Mental Health Experience
PN’s knowledge, experience, as well as support, may influence their attitude towards the mentally ill. According to Mohale (2009) mental health professionals in the past, as well as currently, face a number of factors such as cultural beliefs, stigmatization as well as myths which threaten to derail the successful implementation of mental health into nursing.
This chapter discussed the literature review conducted to gain insight into numerous factors which shape and influence PN’s attitudes and perceptions towards the mentally ill. Both local and international literature was reviewed.
Research Design and Methodology
Presented in this section is a description of the research design and methodology used in the study, including population, data collection, validity and reliability.
This section also outlines the sample, inclusion and exclusion criteria and sampling response. The sampling procedure and a description of the data collection instruments are explained along with data analysis.
3.2 Research Methodology
According to Jonker and &Pennink (2009) research methodology is a particular way in which the researcher conducts research. It is a way in which the researcher decides on a particular question which may result in a problem to address in future.
3.3 Research Design
Differential research can be referred to as a method that compares two or more groups differentiated on the basis of a pre-existing variable and studying this variable in relation to another variable. For the purposes of this study, three groups was categorized based on ‘educational level’, i.e. basic and advanced mental health nursing ‘educational level’ will be studied in relation to the nurses ‘attitudes and perceptions toward the mentally ill’.
3.4 Quantitative Approach
The researcher adopted a quantitative research approach where numerical data was used to obtain information about sample participants in a recognized, objective, systematic process. This method is used to describe variables, examine relationships between variables and determine cause-effect interactions between variables .
3.5 Exploratory Design& Descriptive Design
The study design is explorative and descriptive which is a design typically conducted to describe events or concepts and to discuss the relationship between the concepts and ideas. This design was a good fit for this study as it aimed to quantify and compare the responses of PN’s with diverse mental health qualifications working in an APH in the Cape Metropole.
The cross-sectional survey was carried out, as it was cost-effective and appropriate for this specific type of study. A cross-sectional survey is defined as a survey that collects data from participants at a particular time (Brink & Wood, 1998). Graziano (2004) states that surveys may be used for descriptive and exploratory purposes, which are the case in this study. It was highly effective since the population was well educated.
This study was conducted at Stikland hospital which is one of four psychiatric institutions in the Cape Metropole. The 12 wards include the following specialities: Acute Psychiatry, Therapeutic, Alcohol Rehabilitation, Opioid Detoxification, Acute Psychogeriatric, Medium, Longterm Psychogeriatric, Acute Intensive Rehabilitation occupancy and Intellectual Disability.
3.7 Sample Size
The researcher adopted a non-probability convenience sample in this study as it would not be possible to collect data from all nurses at APH hospitals, nor would all agree to participate in the study. Initially, the sample for the study targeted 90 all permanent employed PN’s working at Stikland hospital (n=90). The study sample comprised of four cohorts of PN’s (n=60), representing four separate education levels (R880 n=18, R212 n=4, R425 n=38, R880+R212=2).
By way of convenience sampling, the selection of units from the population is based on easy availability and accessibility. This is an excellent technique to make use of in exploratory research (De Vos et al, 2005).
3.8 Inclusion and Exclusion Criteria
All PN’s registered at SANC who have completed the R880, R212 or the R425 course and are permanently employed at Stikland hospital were included. All other categories of nurses were excluded from the study.
3.9 Sampling Procedure
The researcher administered sealed envelopes, which included the demographic-, the MHPPQ and the ASMI questionnaires, to the different operational managers of each ward in Stikland hospital. The operational managers distributed the abovementioned questionnaires to PN’s in their ward while on duty. The researcher obtained informed consent for the study by first providing an information letter that explains the study. Data were collected continuously during a 7-week period after written consent was obtained.
Questionnaires tend to be selected for descriptive studies to obtain information from individuals, facts about situations, or the beliefs of the participants.
3.10 Data Collection Instruments
Section A of the questionnaire, the Demographics consisted of 12 questions on age, gender, ethnicity, qualification, psychiatric experience, education level completed in addition to advanced courses. The demographic profile sought the background of the participants in the study, thus giving the researcher an insight into biographical information of the respondent.
Section B of the questionnaire, the Attitude Scale for Mental Illness (ASMI),
a modified version of the questionnaire, Opinions about Mental illness in the Chinese Community (OMICC) (Ng & Chan, 2000),consisted out of 27 items, of Lauder, Reynolds, Reilly, & Angus (2000) was used. This ASMI measured the general attitude towards mental illness. Respondents were given the choice of five response categories based on their feelings from ‘strongly disagree’ to ‘strongly agree’ (strongly disagree = 1,disagree = 2,uncertain =3,agree = 4,strongly agree =5) accordingly.
To ensure validity of the instrument, the questionnaire to be used was adapted from the one used by Hahn (2001) in a similar study.The ASMI scale yielded a Cronbach’s Alpha 0.87 showing high internal consistency among scale items .
Questions were sub-divided into six conceptual factors that measure the following towards the mentally ill: questions 1-9 & 24 measured separatism, questions 12 & 13 measured stereotyping, questions 14-17 measured restrictiveness, questions 18-23 & 25 & 26 measured benevolence, questions 27-30 measured pessimistic prediction, and questions 31-34 measured stigmatization.
Section C of the questionnaire was based on the Mental Health Problems Perception Questionnaire (MHPPQ) from the version by Lauder, Reynolds, Reilly & Angus (2000, 2001), a 7-point Likert scale used to rate nurses’ perceptions of their competence to treat patients experiencing mental illness. The MHPPQ questionnaire consists of 27 questions relating to the perceptions of PN’s working in the mental health field on a 5-point Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’. Professor William Lauder granted the researcher permission to make use of his questionnaire. Once again participants were given the choice of five response categories based on their feelings from ‘strongly disagree’ to ‘strongly agree’ (strongly disagree = 1,disagree = 2,uncertain =3,agree = 4,strongly agree =5) accordingly.
Questions were sub-divided into three conceptual factors that measure the following of PN’s: questions 11-13, 16-25+27 measured therapeutic commitment, questions 8-10+26 measured role support, questions 1-7+14-15 measured role competency.
Therapeutic commitment is influenced by one’s self perceived role competency and role support. Role competency means having the necessary skills, knowledge and understanding of patients within one’s sphere of responsibility; role support is the perceived or potential level of contact with, and access to, specialist mental health workers .
3.11 Data Analysis
Data analysis in quantitative studies are conducted to reduce, organize, give meaning to the data and to address the research aim and its specific objectives (Burns & Grove, 2003).
The quantitative data obtained from the research study was analyzed by means of a statistical program on a computer "Statistical Package for the Social Sciences,"(SPSS) version 19.0. The data is presented in a graph and percentage format.
Descriptive statistics were calculated for the variables of interest, including means, standard deviations (SD) etc. and was analysed thematically. Furthermore, Pearson’s or Spearman’s correlations, where applicable, were calculated for the variables of interest to determine whether any relationship exists between them. For the purposes of this study, the confidence interval was set at 95%. Results of this study need to be interpreted with caution as the sample size was small (n=60) and represented only 67%, which were the response rate of the target population.
Validity indicates whether an instrument measures what it is supposed to measure and has a number of different aspects and assessment approaches to it (De Vos, 2005). To ensure validity of the instrument, the questionnaire to be used was adapted from the one used by Hahn (2001) in a similar study.
Reliability of measure refers to good quality measures that give consistent results regardless of who does the measuring. Thus, a scale is reliable if it at all times give the equivalent reading when measuring the same object . The OMICC scale yielded a Cronbach’s Alpha 0.87 showing high internal consistency among scale items .
3.14 Ethical Considerations
Ethical guidelines serve as a basis upon which a researcher conducting research can evaluate his or her conduct . Furthermore the researcher needs to carefully consider the ethical requirements of research during the planning phase. Ethical considerations are vital to any study because of the influence on the researcher’s ability to acquire and retain participants (Polit&Hungler, 2001).
The following ethical principles were observed in this study:
Right to self-determination
All the subjects were respected and treated with dignity and as autonomous agents. The prospective subjects were informed of their right to decide voluntarily if they wanted to participate in the study (Pilot & Beck, 2004).
3.14.2 Right to full disclosure
The researcher fully described the nature of the research by speaking to each PN personally. The PN’s were informed of their right to refuse participation and asked to sign a consent form (see Appendix – iv), which gave them the option of refusing participation. The researcher also explained researcher responsibility and the risk/benefit ration to the subjects (Polit& Beck, 2004).
3.14.3 Principle of justice
All the subjects received fair treatment and their right to privacy was maintained. Anonymity was ensured, as they had a choice to write their names on the questionnaire (Polit& Beck, 2004).
3.14.4 Principle of beneficence
The researcher has the duty to do good and avoid harm. The reaearche tried to aboid harm to the subjects as they were informed of their right to terminate their participation in the research at any time if psychological harm was predicted (Polit & Hungler, 2004).
3.14.5 Rights of institution
The rights of the institution were protected by fully disclosing the nature of the study and the researchers’ responsibility to the organization. The approval of the necessary authorities was sought in order to ensure that they were informed about the study and to gain their cooperation.
3.14.6 Scientific honesty
Experienced researchers supervised the study to ensure that the researcher was competent to conduct the research. The researcher acknowledged all ideas or work from others used in the study (Brink, 1996).
3.14.7 Informed consent
The prospective subjects were fully informed of the nature, purpose, scope and procedures used to collect the data (Polit & Hungler, 1999). Each subject was furnished with a consent form to sign stating that they had given permission to participate in the study (see Appendix – iv).
Results: Presentation and Discussion
Analysis and interpretation of the data collected during this research study is presented in this chapter. The objectives of this study were to identify the attitude and perceptions of PN’s towards the mentally ill. Additionally to compare if different attitudes is influenced by education and experience in the mental health field and what difference does exit. The primary aim of this research study was to describe the attitudes and perceptions of PN’s towards the mentally ill.
4.2 Data Collection
The researcher collected the research data from the PN’s working at Stikland hospital by using a structured questionnaire, consisting of three sections:
Section A: Socio-demographic information.
Section B: MHPPQ
Section C: ASMI
A sample of sixty (60) PN’s from the Stikland hospital participated in this study during April 2010.
4.3 Socio-demographic information
The socio-demographic information which was collected which included gender, age, ethnicity, education, nursing diploma, nursing degree, completed the advanced mental health course, how long participants have been working in mental health, what ward PN’s is working in currently, and how many years they have been working in each of the following: acute, therapeutic, alcohol rehab, opioid detox, acute psycho geriatrics, long-term psyho geriatric, acute rehab and administration.
Results from a cross tabulation between gender and the opinion on whether people with mental illness have unpredictable behaviour revealed that more female practitioners than male agreed. In terms of percentage, 80 % of the respondents who thought people with mental illness were unpredictable were females. The remaining 20 5 of the respondents were male. However, the general picture was that a great percentage of the respondents fell within the category of agree and strongly agree. This result does foster the impression that most of the medical practitioners have a distrustful attitude towards the character of the mentally ill patients. It would appear that this response was fostered by logical assumptions and experiences with the mentally ill patients within their fields of practice. The same results must be considered alongside the findings that most of the respondents of this study worked under the “acute” and “therapeutic” categories of their field of practice.
The impression obtained from this research is that there is more exposure to mentally ill patients among the respondents increasing the impression that mentally ill patients were generally unpredictable. It is to be expected that this kind of impression would determine the reaction of the nursing practitioners towards the mentally ill patients. A second cross-tabulation showed that a majority of the respondents making up 41.6 % who agreed that mentally ill patients had unpredictable behavior did not have advanced mental health course. This was followed by 33.3 % of the respondents who agreed strongly that mentally ill patients were given to unpredictable behaviour. This category did not also have advanced course in nursing. On the other hand, only four respondents who agreed that mentally ill patients had unpredictable behaviour had completed an advanced mental course in nursing. From these results it may be inferred that nurses who have completed an advanced course in higher training are more tolerant in their opinions about mentally ill patients.
Accordingly, it might be argued that increased levels of training have the effect of bringing about a positive attitude among nurses concerning mentally ill patients. Cross tabulations were also conducted between the opinion on whether people with mental illness will become ill again, and whether the respondents had completed an advanced degree in nursing. From the results obtained, it shows that most of the respondents who thought mental illnesses have a capacity to recur did not complete an advanced course in mental health. The results therefore illustrate the fact that nurses attitudes towards mentally ill patients vary with the levels of education. This finding would reinforce the impression that increased levels of knowledge have a direct bearing on attitude development among the nurses.
Among those who had completed an advanced course in mental health, only four representing a slim minority of 6.7 % of the group was of the opinion mental illness could recur in people who had suffered it before. Still on the matter of education versus perceptions, the study sought to relate the level of education to the opinion on whether respondents could live with mentally ill patients in the same community. The results showed that those who strongly disagreed with the opinion did not receive any advanced level training in mental health care. The same results were cross-tabulated against the respondents’ ethnicity. The results did show that white nurses were less concerned by mentally ill patients in their midst than either blacks or Indians.
Conclusions and Recommendations
5.3 Study Limitations
There are a few limitations expected in this research study and they include the following:
1. As with every other investigation, the fact that participants may not be precisely accurate in answering the questionnaires was detected.
2. Even though the whole nursing population of 90 nurses working at Stikland hospital, a few participants were not available during the time of the study.
3. Seeing that the researcher was a former member of the group selected for this study, participants felt hesitant to reveal exact truthful information on the questionnaires for fear of coverage.