Understanding the impact of mental health placements on student nurses’ attitudes towards mental illness

Student nurses maintain unfavorable views of people with mental health issues. Many continue to perpetuate common stereotypes, are fearful and believe people with mental health problems are in some way dangerous. The impact of placements greatly affects these views. A pre-post survey of 85 student nurses was conducted to establish the opinions and attitudes of student nurses regarding mental health. Groups were allocated to either community or hospital placements. Each group received the same educational preparation prior to placement. Both community and hospital placed students had improved clinical confidence when working with people experiencing mental health problems. Community placed students demonstrated greater positive attitudes towards people experiencing mental health issues across a number of domains. Students in hospital settings demonstrated more confidence when working with people with mental health issues yet had less attitudinal change about mental health. The approach taken by clinical facilitators also influenced student attitudes. It is suggested that offering community opportunities along with exposure to positive instructor beliefs about mental illness will both improve student attitudes prior to the completion of their nursing studies and may encourage entry into mental health as a nursing option post-education.     

Nurses'' behavioural intentions towards self-poisoning patients: a theory of reasoned action, comparison of attitudes and subjective norms as predictive variables

BACKGROUND: The incidence of self-poisoning is on the increase. Most patients who self-poison are dealt with initially in the general hospital. Therefore, the type and quality of care self-poisoning patients receive will depend, in part, on how they are viewed by nursing staff within the general hospital setting. A knowledge and understanding of the attitudes held by nurses towards self-poisoning patients is therefore important to those involved in the planning and delivery of care towards this client group. Previous studies have examined health care professionals' attitudes towards people who self-poison. Usually, however, these have not focused specifically on nurses' attitudes, and they have ignored the relationship between the attitudes expressed by staff and their intentions to engage in subsequent caring behaviour of one sort or another. It is hence unclear how the findings of such studies are relevant or applicable to nursing policy and practice. AIMS: The present study aims to address these limitations using a methodology informed by the theory of reasoned action. The study aims to separate out the distinctive roles played by nurses' own attitudes, and the social pressures represented by other people's attitudes, in determining the types of caring behaviour in which nurses intend to engage when dealing with self-poisoning patients. DESIGN/METHODS: The study adopts a questionnaire-based approach incorporating two specially designed vignettes. RESULTS: The results show that nurses' own attitudes, and what they believe about the attitudes of others, predict their behavioural intentions towards self-poisoning patients. The study also shows that nurses with a more positive orientation towards self-poisoning patients differ in behavioural and normative beliefs from nurses who have a less positive orientation. CONCLUSIONS: The implications for future attempts to explore the relationship between nurses' attitudes and subsequent caring behaviour are considered, along with implications for nursing policy and practice.     

Attitudes towards hospitalized older adults

BACKGROUND: A number of studies have explored nurses' attitudes toward older people. However many of those have produced inconclusive results. Moreover dated attitudinal measures have been used to answer a broad range of questions relating to older people. AIM: The aim of this paper is to report a study examining whether negative attitudes and beliefs toward older adults persist. METHODS: Focus group interviews were used identifying factors which may influence attitudes and beliefs both negatively and positively. Nine Registered Nurses from care of older adult areas, four from acute areas, six nurse teachers, and 17 nursing students participated in the study. Ten themes were identified from the findings. FINDINGS: The findings show that the student nurses had varying experiences in older adult settings. Some of which had the effect of turning them away from the specialty. However, nurses who worked with older adults were very positive about their work and the nursing opportunities they had to offer student nurses. They were rather critical of the content of the pre-registration curriculum, which they perceived to over-rely teaching the negative aspects of ageing, and there was also criticism of the currency of teachers' knowledge. Nurses who worked in acute settings also did not escape criticism, in that they were identified as attributing a lack of sense of humour to older adults. The limitations include the small sample size although it is congruent with qualitative research. CONCLUSIONS: All nursing staff need to be more aware of their influence on the attitudes of student nurses toward older people. Good practice includes the ability to demonstrate that older people in hospital settings are valued. Nurse teachers need to review the way they prepare students for this specialist work in order to avoid inadvertently conveying negative attitudes.     

Attitudes towards disability in an undergraduate nursing curriculum: a literature review

In the process of introducing a new disability unit into an undergraduate nursing curriculum in a New Zealand educational setting, the opportunity arose to conduct a small study comparing the attitudes of student nurses towards people with disabilities. This paper discusses the literature reviewed, which formed the basis for the study. A range of perspectives and research was identified that explored societal and nurses' attitudes, disability studies in undergraduate nursing curricula, the impact of nurses' attitudes on patient care, and interventions for changing those attitudes. Effective nursing care can be severely compromised through negative attitudes, and concerns are expressed at the lack of attention given to this issue in nursing curricula generally. The literature showed that combining educational approaches with opportunities for student nurses to interact with disabled people provides the most effective means for student nurses to develop positive attitudes towards disabled people. The goal for nurse educators is to ensure the inclusion of disability studies as a core component in undergraduate nursing education.     

A comparison of nurse teachers' and student nurses' attitudes toward hospitalised older adults

Studies have demonstrated that gerontological content can have a positive effect on student nurses' attitudes toward older adults. However, few studies have attempted to investigate nurse teachers' attitudes toward older people. Yet authors acknowledge the importance of both clinical nurses and teachers in the socialisation process. The aim of this study is to compare the attitudes of student nurses with those of nurse teachers toward working with hospitalised older adults. A questionnaire was developed, piloted and refined until the final outcome was a 20 item questionnaire. The questionnaire was distributed to nurse teachers (n=59); first year student nurses who had completed their first term of theory (n=82); student nurses who had completed a theory and a clinical placement (n=80). Statistical analysis of the data included ANOVA with a post hoc comparison. Results indicated that nurse teachers were most positive for a number of items on the questionnaire. However, they were least positive about their role in promoting an interest in older people and keeping up to date about advances in the field of older people. It is the responsibility of both teachers and clinical staff to dispel stereotypes that student nurses bring in to nursing.     

Nurses' attitudes to palliative care in nursing homes in Western Australia

Nursing homes are one of the care settings in Western Australia where older people may spend their final years. Residents should be able to receive palliative care where appropriate, but this type of care is not always available at some nursing homes in the state. This study investigated nurses' attitudes to palliative care in nursing homes by examining their cognitive, affective and behavioural information. A sample of 228 nurses working in nursing homes completed a questionnaire, using a free response methodology. Results showed that participants had either a positive or negative attitude to palliative care. Cognitive and affective information significantly and independently predicted the attitudes of nurse, whereas knowledge of palliative care did not contribute significantly to these attitudes. Nurses currently working in palliative care were more positively disposed towards such care, but this disappeared when they ceased working in the area. There is an emphasis on education in the literature which does not take into account the beliefs and emotions of the nurse. Therefore, there is a need to consider these in undergraduate and postgraduate training for nurses. Current experience is also important in palliative care education. The results obtained from nurses in this study should be incorporated into policy for introducing palliative care into nursing homes and used to provide support and assistance to nurses working in this field.     

HIV/AIDS and the workplace: perceptions of nurses in a public hospital in South Africa

AIM: The purpose of this article is to report a study of the perceptions and experiences of nurses caring for people living with HIV/AIDS in the public health sector in South Africa. BACKGROUND: The number of people living with HIV/AIDS in South Africa has escalated at an alarming rate. Many people being hospitalized are HIV positive, and hence nurses are in more regular and prolonged contact with people suffering from HIV/AIDS than is the case in other working environments. Although studies focusing on nurses' experiences of caring for patients with HIV/AIDS have been done in numerous countries, little is known about nurses' views in Africa, and South Africa in particular. To ensure quality care for patients with HIV/AIDS, it is important to understand nurses' experiences of nursing HIV-positive patients and how they may influence their attitudes towards these patients. METHOD: A qualitative approach was used, the primary method of data collection being in-depth interviews. These interviews were conducted with 35 nurses at a public hospital in the Gauteng province of South Africa in 2002-2003. FINDINGS: Seven themes were identified: helplessness, emotional stress and fatigue, fear, anger and frustration, occupational-related concerns, empathy, and self-fulfilment. CONCLUSIONS: Increased understanding of the stresses and rewards experienced by these nurses can contribute to policy development in this area. It is also important to provide appropriate preregistration and continuing education and support for nurses working in this field, and to ensure that the working environment is adequate in terms of resources.     

Attitudes and stereotypes: nurses' work with older people

The study reported here sought to describe the differences between nurses' attitudes towards work with older people in the collective sense and their attitudes towards the individuals with whom they work A convenience sample of 136 community nurses was obtained Data were collected by means of a questionnaire incorporating the report of two critical incidents — one of effective practice and one of ineffective practice with older people In addition in-depth qualitative interviews were conducted with 22 respondents The findings lead the authors to challenge the common assumption that an identified lack of desire in nurses to work with older people is due solely to negative attitudes which nurses hold towards older people themselves The paper concludes that the high dependency levels of older people and structure of nursing work with older people in hospitals means that fewer nurses make this area a positive career choice     

What influences student nurses’ intention to work with older people? A cross-sectional study

BackgroundStudies have reported that student nurses hold positive attitudes towards older people; nevertheless, working with older people has consistently remained one of the least desired career choices among student nurses in most countries.ObjectivesThe current study aimed to assess student nurses’ intentions to work with older people and to determine the predictors of working intentions among nursing students.DesignThe study adopted a cross-sectional design.SettingsMultistage sampling was used to recruit nursing students from five states in Malaysia.ParticipantsA total of 1462 nursing students from eleven nursing education institutions participated in this study.MethodsA self-administered questionnaire was used to collect data. This study is underpinned by the Theory of Planned Behaviour. The Intent to Work with Older People Scale and Kogan Attitudes Toward Old People Scale were used to assess nursing students’ intentions and attitudes towards care of older people respectively. Researcher-developed instruments were used to assess subjective norms and perceived behavioural control among nursing students.ResultsThe present study found that nursing students in Malaysia demonstrated a moderate level of intention to work with older people, with a mean of 39.72 (±4.38). There were significant differences in effects of gender, ethnic group, academic level, type of nursing institution and setting of older person care clinical experience on intentions to work with older people. There was a moderate and positive relationship between attitudes towards older people and intentions to work with older people, as well as between perceived behavioural control and intentions to work with older people; it was found that r = 0.36 for both relationships. Attitudes, subjective norms and perceived behavioural control accounted for 19.7% of the variance in intentions to work with older people.ConclusionThe primary findings of this national study revealed that Malaysian nursing students have a moderate level of intention to work with older people. It is imperative to develop educational interventions to nurture attitudes for caring and promote stronger intentions to work with older people.     

Transforming students' views of gerontological nursing: realising the potential of 'enriched' environments of learning and care: a multi-method longitudinal study

BACKGROUND: Gerontological nursing is often viewed as unchallenging and is rarely a positive career choice for student nurses. Issues of recruitment and retention in gerontological nursing are a global phenomenon and strategies are needed to encourage more students to opt for this area of work. AIMS AND OBJECTIVES: To identify the role and influence of students' learning experiences on shaping their predispositions to work with older people and to identify the characteristics of a positive learning environment that might promote a more favourable view of gerontological nursing. METHODS: The study was a 312-year longitudinal investigation using multiple methods of data collection and analysis, including an extensive review of the literature, large-scale postal surveys, focus groups and case studies of clinical placements. The design of the study was emergent and essentially constructivist, and participants, especially student nurses, were actively engaged in the on-going process of data analysis. FINDINGS: The results suggest that students do not necessarily enter nurse training with negative predispositions towards work with older adults, but that such negative views develop during their training largely as a result of clinical placements and extra-curricula paid work. Student nurses are often exposed to 'impoverished' environments of care in which they witness poor standards of care and negative attitudes towards older people. However, if they experienced 'enriched' environments they are far more likely to view gerontological nursing in a favourable light. The characteristics of an enriched environment can be understood using the Senses Framework as an analytic lens to interpret students' learning experiences. RELEVANCE TO PRACTICE: The study reinforces the vital role that the placement experience plays in helping students to identify with a particular area of practice. The promotion of an 'enriched' environment of learning and care can be used to help ensure that students have a positive experience of learning to care for older people.     

Developing a questionnaire to measure nurses' attitudes towards hospitalized older people

A number of studies have used generic measures to evaluate nurses' attitudes toward hospitalized older people. Those measures do not consider the context in which nurses meet older people and the influence that this may have on nurses' attitudes. The aims and objectives of the study were to develop a questionnaire from focus group data to evaluate nurses' attitudes towards hospitalized older people. To evaluate the psychometric properties of the questionnaire the design included a qualitative and quantitative phase. The method used for the qualitative phase was focus group interviews with the intention of identifying the phenomena that may indicate nurses' attitudes towards older people. The quantitative phase included the development and psychometric testing of an attitudinal questionnaire. Samples for the qualitative phase included Registered Nurses from the care of older people setting; Registered Nurses from the acute setting; nursing students and nurse teachers. The sample for the quantitative phase included nursing students (numbering 355). Ten themes were identified through thematic analysis. Eighty items were extrapolated from the qualitative analysis and used to formulate a questionnaire which was then distributed to the nursing students. On analysis, the reliability was 0.78. Further analysis using Principal Components Analysis (P.C.A.) with orthogonal rotation indicated that 45 items loaded on to eight factors. Results of the quantitative analysis indicated that there was a strong correlation between the thematic analysis and the P.C.A. The results would suggest that there may be important and relevant domains that are worthy of further study into nurses' attitudes towards older people. If the domains identified are useful for identifying negative attitudes towards older people, then strategies can be implemented to try and reduce negative attitudes in clinical practice.     

Introduction of assistive devices: home nurses' practices and beliefs

AIMS: This paper reports a study describing home nurses' intention and current practices regarding introducing assistive devices, and investigating whether their practice is related to social cognitive factors (attitudes, subjective norms and self-efficacy). BACKGROUND: Home nurses not only care for patients in particular medical domains, but also educate and guide them towards more independence. Patients with age-related disabilities in mobility and self-care might benefit from the use of assistive devices. A home nurse might be the first and only person to discuss the disability and use of an assistive device. Therefore, home nurses' beliefs about the introduction of assistive devices could affect their daily practices. METHODS: A cross-sectional study was conducted with a convenience sample of 64 home nurses chosen from a random sample of home nursing departments. The home nurses completed a self-administered questionnaire. The Theory of Planned Behaviour framework was used to develop the social cognitive measures regarding each of the six steps distinguished in the introduction of assistive devices. RESULTS: Home nurses had positive attitudes and high levels of intention, subjective norm and self-efficacy towards most steps of the decision process to introduce assistive devices. In a multiple linear regression analysis, attitude and self-efficacy predicted intention to introduce assistive devices to older clients with disabilities. Intention was correlated to home nurses' current practices. CONCLUSIONS: The findings suggest that conditions are present to involve home nurses more explicitly in the introduction of assistive devices to their patients. Social cognitive factors should be taken into account when developing interventions that aim to support home nurses to do this.     

Nurses attitudes towards the importance of families in psychiatric care following an educational and training intervention program

This study measures the attitudes of the psychiatric nurses, after having received an education and training intervention program (ETI-PROGRAM) in family systems nursing, towards the importance of the families in their care. Nurses' knowledge of the impact that family nursing intervention can have on family members may increase positive attitudes towards families. However, little is known about the impact that education and training intervention can have on nurses' attitudes, towards families in clinical practice. Quasi-experimental design was used to assess the change in nurses' attitudes towards families in psychiatric care after the intervention, which included a one-day seminar on the Calgary family nursing conceptual frameworks and skills training with clinical vignettes of families from psychiatry. The Families Importance in Nursing Care - Nurses' Attitude questionnaire was used to evaluate nurses' attitudes. A total of 81 nurses (65%) working in psychiatric care responded to the questionnaire. Nurses with more than 15 years of work experience were significantly more supportive of families in their care compared with less experienced nurses. Out of the 81 nurses, 52 (64%) answered the questionnaire again 14 months later. Furthermore, psychiatric nurses saw families significantly less burdensome after having participated in the ETI-PROGRAM.     

Student nurse attitudes towards homeless clients: a challenge for education and practice

The purpose of this research was to describe attitudes of nursing students (and paramedic officers) towards marginalized clients. Convenience quota sampling in a major health faculty was employed. Students participated on a voluntary basis. A 58-item Likert scale, developed by the authors, assessed the student nurses' attitudes. In general, attitudes towards homeless clients were neutral; detailed analyses, however, revealed that student nurses would decline to care for homeless clients in various situations. Personal experience with homeless patients and positive attitudes of nurses significantly contributed to increased quality of care and equality of treatment for homeless clients. Certain student nurse behaviors warrant immediate attention to prevent marginalized patients from being exposed to unfair, inaccessible and biased nursing care. Based on our results, we recommend that further research attention be paid to the role of ethics education and faculty behaviors, as faculty members serve as role models for professionalization.     

Nurses' attitudes to terminally ill patients

BACKGROUND: The care of terminally ill patients is a challenge for nurses that has raised special interest in recent years. Several studies have shown a stereotyped negative attitude in nurses towards terminally ill patients. However, all have used methods with several limitations. AIM: The aim of the study presented in this paper was to identify the nurses' attitude to the terminally ill patient in Catalonia, Spain, and the relationship of this attitude to different socio-demographic data (type of centre, shift, years of experience, age and sex) by means of a new quantitative method based on the free word-association test. METHODS: One hundred and seventy-five nurses working in 18 hospitals and hospices in Catalonia, Spain were included in the study. Data were analysed by the Associative Semantic Field Differential method by means of the computer programme CONTEXT and a quantitative evaluation of the degree of attitudes positivity was obtained. RESULTS: The study revealed a general slight negative trend in attitudes towards the terminally ill patient. A more positive attitude was observed in older caregivers and in women. The positivity in attitude decreased from morning to night shift. No differences were observed between nurses working in hospitals and those working in hospices. CONCLUSIONS: We conclude that nursing attitudes can be analysed by methods such as that used in this study. Attempts can be made to modify this attitude in caregivers by means of training programmes and stimulating awareness of an adequate professional approach.     

A study of nurses'' attitudes towards associate degree nursing students

The purpose of this study was to examine the attitudes of staff nurses towards associate degree (AD) nursing students. The null hypothesis stated there will be no significant difference in the attitudes of staff nurses towards AD nursing students and associated concepts (nursing education, patient, physician, work, nurse.) The staff nurse's value as a role model is held in high regard yet little regard is given to her attitudes towards students. Through better understanding of staff nurses' attitudes, nurse educators can better plan, develop and coordinate clinical activities to provide an optimum learning environment. The findings showed the concept AD nursing student was significantly different from the rest, indicating a less positive attitude towards the AD nursing student than the related concepts. Implications for nursing practice are threefold. Nurse administrators must create an atmosphere and a philosophy which support the educational process within their institution, and recognize nurses' attitudes towards students. Practising nurses should examine their attitudes and willingness to work with students if their hospital offers their agency as a clinical facility. Educators must look closely at the units they assign students to, continually maintaining the lines of communication between staff nurses and clinical instructors. As service and education work together a quality environment can be provided in which there is optimum learning for the student. Both groups then contribute to the future of professional nursing.     

Angel, handmaiden, battleaxe or whore? A study which examines changes in newly recruited student nurses' attitudes to gender and nursing stereotypes

This article presents the findings of a comparative study, which investigated the attitudes of two groups of newly recruited student nurses to gender and nursing stereotypes. The 1992 sample (n=100) was a group of student nurses who were in their second day of studies of a Project 2000 type curriculum. The 2002 sample (n=96) were in their second month of studies of a "Fitness for Practice" curriculum [Fitness for Practice (the 'Peach Report'), UKCC, London, 1999]. Data were collected using a questionnaire, which utilised a Likert scale for measurement of attitudes to statements pertaining to gender and nursing stereotypes. The findings reveal significant differences between the characteristics of the two groups of students. For example, the 2002 group were generally older and had more healthcare experience. However, male representation in the sample groups was similar. The overall high scores and implied propensity towards beliefs in gender and nursing stereotypes in the 1992 study was found not to be the case for the 2002 sample. This is particularly true of most statements related to gender stereotypes, nursing as 'feminine', male nurse stereotyping and issues related to nurses' uniform. However, there is less evidence of changes in attitudes towards female nursing stereotypes with indecision being a general feature of both the 1992 and 2002 responses.