Modeling attitudinal antecedents of nurses' decisions to report impaired colleagues

Nurses whose professional functioning is impaired due to substance abuse represent a threat to the health and safety of patients, other health care staff, and themselves. The major means for identifying impaired nurses is nonimpaired coworkers. Yet, only 37% of nurses who have had experiences working with impaired colleagues reported them to supervisors. A cross-sectional correlational research design, employing structural equation modeling, was used to explicate the relationships among the latent attitudinal constructs: permissiveness, morality, treatment efficacy regarding substance abuse, and punitive attitudes toward impaired nurses. The influences of these attitudes on perceived severity of impairment in fictitious coworkers and subsequent intentions to report these coworkers to nursing supervisors were modeled in a sample of 126 nurses. Permissiveness and positive attitude toward treatment were significantly related to intentions to report nurses. Moralistic attitude was not related to intention. Moralistic attitude was, however, strongly associated with a punitive attitude toward impaired nurses.     

How Do Nursing Students Perceive Substance Abusing Nurses?

Substance abuse among nurses was recognized by nurse leaders and professional nursing organizations as a growing threat to patient safety and to the health of the abusing nurse more than 30 years ago. Although numerous studies on nurse impairment were published in the 1980s and 1990s, there was minimal focus on student nurses' perceptions about impaired nurses and less research has been published more recently, despite a growing rate of substance abuse. A quasi-experimental study to explore the perceptions of student nurses toward nurses who are chemically dependent was conducted using a two-group, pretest–posttest design. The Perception of Nurse Impairment Inventory (PNII) was completed by student nurses at the beginning of their junior course work, prior to formal education about substance abuse. The PNII was repeated after the students received substance abuse education. The PNII was also completed by a control group of sophomore student nurses who did not receive the formal substance abuse education. A repeated measures analysis of variance was used to measure the differences between the two groups of students. Students who received the education chose more compassionate responses on the PNII and were more likely to respond that an impaired nurse's supervisor is responsible for supporting and guiding the impaired nurse to access professional care. Discrepancies in study findings about the efficacy of education for effecting positive attitudes of student nurses toward impaired nurses may be related to the length and type of the education.     

Attitudes of registered nurses toward perceived substance abusing peers and education specific to substance abuse

A randomized study of 86 senior registered nurse BSN student nurses was conducted to: 1) examine registered nurses' awareness of the effects of substance abuse on their profession; 2) determine their attitudes toward education specific to substance abuse; 3) determine attitudes toward peers perceived as substance abusers; and 4) elicit responses to viewing education as a possible deterrent to drug addiction. Factor analysis for the subscales yielded Cronbach alpha coefficient reliabilities of 0.78 to 0.39. Selected cross tabulations for the independent variables showed no significant influence on the attitudes of respondents. A significant percentage of respondents believed that there was a drug problem in the profession, supported the idea of an educational program on substance abuse, and felt that a specific course could be a deterrent to drug addiction. A significant number also wanted to support the chemically impaired nurse but were less positive about the return of this person to the work place before complete rehabilitation.     

Attitudes toward physician-nurse collaboration: a cross-cultural study of male and female physicians and nurses in the United States and Mexico

BACKGROUND: Inter-professional collaboration between physicians and nurses, within and between cultures, can help contain cost and insure better patient outcomes. Attitude toward such collaboration is a function of the roles prescribed in the culture that guide professional behavior. OBJECTIVES: The purpose of the study was to test three research hypotheses concerning attitudes toward physician-nurse collaboration across genders, disciplines, and cultures. METHOD: The Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was administered to 639 physicians and nurses in the United States (n = 267) and Mexico (n = 372). Attitude scores were compared by gender (men, women), discipline (physicians, nurses), and culture (United States, Mexico) by using a three-way factorial analysis of variance design. RESULTS: Findings confirmed the first research hypothesis by demonstrating that both physicians and nurses in the United States would express more positive attitudes toward physician-nurse collaboration than their counterparts in Mexico. The second research hypothesis, positing that nurses as compared to physicians in both countries would express more positive attitudes toward physician-nurse collaboration, was also supported. The third research hypothesis that female physicians would express more positive attitudes toward physician-nurse collaboration than their male counterparts was not confirmed. CONCLUSIONS: Collaborative education for medical and nursing students, particularly in cultures with a hierarchical model of inter-professional relationship, is needed to promote positive attitudes toward complementary roles of physicians and nurses. Faculty preparation for collaboration is necessary in such cultures before implementing collaborative education.     

Attitudes of staff towards mothers affected by substance abuse

The purpose of this study was to explore the influence of education and experience on the attitudes of neonatal nurses/midwives when caring for mothers and infants affected by substance abuse. A self-report questionnaire was completed by 50 nurses/midwives. The attitude of nurses/midwives towards mothers affected by substance abuse was generally negative/judgemental, and their knowledge base was low. The most experienced nursing staff generally had a more negative attitude than those nurses/midwives with less neonatal experience. Formal neonatal education did not appear to have a positive effect on knowledge base or attitudes; however, results implied that in-service education on substance abuse might have a mildly positive effect on attitudes. Results indicate a need for formal education on substance abuse and its effect on the neonate and mother, and that specialist education on substance abuse may influence attitudes.     

Computers in nursing practice. A comparison of the attitudes of nurses and nursing students

This study was undertaken to compare the attitudes of nurses and nursing students toward computer use in nursing practice and to clarify factors that influence these attitudes. Three factors within the student sample were examined: changes over time, prior experience with computers, and attitudes toward technology in general. Second, the attitudes of the nursing students were compared with those of a sample of practicing nurses. Finally, the multidimensional structure of Stronge's attitude scale was analyzed. A total of 353 sophomore nursing students and 358 staff nurses participated in the study. The analysis produced a refined 17-item attitude scale composed of three identifiable subscales: computers and patient care, computers and personal security, and general attitude. It was found that students had less experience with computers than the investigators had anticipated, and there was little change over three successive cohorts of students. However, in general, students' attitudes toward computer use in nursing were positive, and the more computer experience students had, the more positive their attitudes. The attitudes of the practicing nurses also were generally positive, but differences between students and nurses were observed.     

Texas nurses respond to mandatory continuing education

This study investigated Texas nurses' attitudes toward mandatory continuing education, and their perceptions of skill improvement, knowledge enrichment, and improvement of health care to the public as a result of participation in continuing education programs. Seventy-two percent of the respondents had a positive attitude toward mandatory continuing education. Significant relationships were present between the attitudes and the perceptions of psychomotor skills improvement, cognitive improvement, affective skills improvement, and health care to the public. Four variables were predictive of the attitude toward mandatory education. In addition, the nurses preferred lecture or discussion formats and independent providers of continuing education.     

Substance abuse among nurses: types of drugs

Substance abuse among nurses can have significant ramifications for patient care, productivity, and personal well-being. Existing evidence suggests that critical care nurses are especially vulnerable to pressures that induce substance abuse. Consequently, critical care leaders and nurses need to be prepared to help their impaired colleagues. This paper provides several valuable guidelines for addressing substance abuse based on an exploratory study of the types of drugs or substances most frequently abused among nurses.     

A cluster analysis to investigating nurses' knowledge, attitudes, and skills regarding the clinical management system

Nurses' knowledge, attitudes, and skills regarding the Clinical Management System are explored by identifying profiles of nurses working in Hong Kong. A total of 282 nurses from four hospitals completed a self-reported questionnaire during the period from December 2004 to May 2005. Two-step cluster analysis yielded two clusters. The first cluster (n = 159, 56.4%) was labeled "negative attitudes, less skillful, and average knowledge" group. The second cluster (n = 123, 43.6%) was labeled "positive attitudes, good knowledge, but less skillful." There was a positive correlation in cluster 1 for nurses' knowledge and attitudes (rs = 0.28) and in cluster 2 for nurses' skills and attitudes (rs = 0.25) toward computerization. The study showed that senior and more highly educated nurses generally held more positive attitudes to computerization, whereas the attitudes among younger and less well educated nurses generally were more negative. Such findings should be used to formulate strategies to encourage nurses to resolve actual problems following computer training and to increase the depth and breadth of nurses' computer knowledge and skills and improve their attitudes toward computerization.     

The attitudes of casualty nurses in Taiwan to patients who have attempted suicide

Aims and objectives. The aims of this study were to investigate a sample group of casualty nurses’ attitudes towards patients who have attempted suicide in the middle of Taiwan and to identify factors contributing to their attitudes towards attempted suicide. Design. A quantitative study using a questionnaire containing 22 statements with a five‐point Likert‐type scale was developed from the Domino's Suicide Opinion Questionnaire, and from a comprehensive analysis of research literature on the area of attitudes towards suicide. Methods. The questionnaire was distributed to casualty nurses (n = 155) to investigate their attitudes toward patients who have attempted suicide. Seven large hospitals in the middle of Taiwan were targeted. Results. This sample group of casualty nurses from the middle of Taiwan held positive attitudes toward patients who have attempted suicide. In addition, three statistically significant differences were identified: (i) The higher the level of nursing education the more positive the nurses’ attitudes towards patients who had attempted suicide. (ii) The casualty nurses who did not have a religion held more positive attitudes towards suicidal behaviour than those who followed a religion. (3) Casualty nurses who had suicide care experience with 1–10 patients had more positive attitudes towards suicidal patients than nurses who had nursed above 10 patients who had attempted suicide. Conclusions. The results indicated that casualty nurses in Taiwan require further education on and training in all aspects of suicide to foster more positive attitudes towards patients who attempt suicide. Relevance to clinical practice. The role of casualty nurses is pivotal to the front‐line care of people who are suicidal and their attitudes play a major part in the provision of effective care.     

Physician-nurse attitudes toward collaboration in Istanbul's public hospitals

The need for greater collaboration between nurses and physicians in clinical practice is essential to improve patient care and worker satisfaction. This study used t-tests and logistic regression to test four research hypotheses concerning attitudes toward physician-nurse collaboration in Istanbul, Turkey. The study found that nurses express more positive attitudes toward collaboration than physicians. Noteworthy was the finding that male physicians expressed more positive attitudes toward collaboration than female physicians. Residents and those employed in secondary institutions were also more likely to express more positive attitudes toward collaboration than permanent physicians and those employed in tertiary hospitals.     

Relationship Between Cross-Cultural Health Attitudes and Community Health Indicators

Improving health standards both nationally and cross-culturally is a goal for all community health nurses. Previous research has supported links between health attitudes and behavior. The purpose of the present study was to investigate the relationship between attitudes toward health and indexes of community health using a cross-cultural data set. Concepts selected from the data set were I (myself), body, sickness, disease, life, doctor, health, medicine, hospital, nurse, death, and insane. Community health indicators were male and female life expectancy, infant mortality, economic and public health expenditures, and net social progress. The original sample included 1200 high school males within each of 30 language and cultural communities. Data were derived from students' ratings of the dimensions of evaluation, potency, and activity for each concept. The results supported the association between attitudes and objective community health indicators. Unexpected negative correlations were found between attitudes toward medicine and nurse attitudes toward body and life, perhaps indicating that extended contact with health care providers may result in negative attitudes toward them. Positive relationships were found between public health expenditures and nurses, indicating that in countries with more expenditures for community and public health, attitudes toward nurses were more positive.     

精神科医护人员对精神疾病态度的调查

目的了解精神科医护人员对精神疾病的态度,提高对精神病人的接纳程度。方法采用精神疾病态度调查问卷对120名医护人员进行调查,比较医生、护士的态度差异。结果医生对精神病的治疗态度较护士乐观（P〈0．05）,护士更倾向于同意有精神病史的人可以结婚和生育（P〈0．05）。结论精神科医生和护士对待精神障碍的态度基本一致,这有利于促进精神障碍病人的治疗、康复。同时需要采取相应的对策,提高医护人员对精神疾病的认识和接纳程度,提高护士对精神病治疗的信心。     

AIDS and Homosexuality: A Longitudinal Study of Knowledge and Attitude Change Among Rural Nurses

With no effective medical treatment or vaccine for acquired immunodeficiency syndrome (AIDS) available now or in the near future, nursing can make the most difference by providing emotional support and physical care for people with AIDS and their families. One of the least understood areas in providing such care is the feelings nurses have toward persons with AIDS, especially in rural areas. This study measured changes in knowledge and attitude toward AIDS and homosexuality before, immediately after, and three months after an all-day AIDS workshop for nurses. The program provided current knowledge about transmission of the human immune virus and risk behaviors, and addressed personal feelings regarding fear of caring for persons with AIDS as well as negative feelings associated with homosexuality. Results revealed significant positive changes in knowledge and attitudes three months later. Participants also became significantly less fearful and more willing to care for persons with AIDS. Feelings of fearfulness and willingness to care for people with AIDS were associated not with knowledge differences but with differences in attitudes toward the disease and homosexuality. Therefore, this program's affective component was more closely associated with precursors to behavior change than was cognitive education. As the education needs of rural and community nurses increase, programs specific to them must continue to be developed and studied. Future research must also explore and evaluate actual nursing care of AIDS patients in relation to education program objectives.     

Integrating Web-based technology into distance education for nurses in China: computer and Internet access and attitudes

To increase continuing education accessibility, nurses around the world are turning to Web-based instruction. However, for Internet education to be successful, particularly in developing countries, nurses must have access to computers and the Internet as well as positive attitudes toward this form of learning. As part of a distance education project for nurses of the Tianjin Municipality in China, a survey of nurses was conducted to examine their sources of professional knowledge as well as their computer and Internet access and attitudes. The attitudes of the nurses were generally positive, and there was evidence of rapidly increasing use of and access to computers and the Internet. This article reports the results of that survey and their implications for Web-based teaching of Chinese nurses.     

Nurses’ perceptions of spiritual care and attitudes toward the principles of dying with dignity: A sample from Turkey

Spiritual care is vital for holistic care and dying with dignity. The aim of this study was to determine nurses’ perceptions of spiritual care and their attitudes toward dying with dignity. This study was conducted with 289 nurses working at a public hospital. Results showed three things. First, spiritual care perceptions and attitudes toward dying with dignity were more positive in female participants than in male participants. Second, there was a correlation between participants’ education levels and their perceptions of spiritual care. Third, there was also a correlation between participants’ attitudes toward dying with dignity and their perceptions of spiritual care.     

The attitudes of forensic nurses to substance using service users

There is now a body of research that has shown that the attitudes of nurses towards substance misuse in the mentally ill are generally suboptimal and this has an impact on the quality of nursing care provided. Despite this, to date there have been no published studies that have examined the attitudes of forensic nurses towards substance misusing forensic service users. Sixty-three multiethnic registered forensic psychiatric nurses based on an inpatient unit in outer London were surveyed using the Substance Abuse Attitude Survey (SAAS). This has five subscores: Treatment Intervention, Treatment Optimism, Permissiveness, Non-Moralism and Non-Stereotypes. Only Permissiveness scores were at an optimum level and equivalent to other community mental health workers. The Treatment Intervention and Treatment Optimism subscores were well below those of a multidisciplinary group of community mental health workers. Three other findings were of note. Firstly, women had higher Non-Moralism scores than men. Secondly, staff nurses had higher Non-Stereotypes scores than other grades. Finally, Black nurses had higher Treatment Optimism scores than non-Black colleagues. In conclusion, the attitudes of forensic nurses towards substance misuse in forensic clients are more suboptimal than other groups of community mental health workers. Our findings also indicate that gender, staff grading and ethnicity are associated with suboptimal scores.