Modification and Initial Psychometric Evaluation of the Physical Health Attitude Scale for Use in the Canadian Mental Health and Addictions Context

Introduction: The Physical Health Attitude Scale (PHASe) tool was developed to better understand mental health nurses’ attitudes towards their involvement and confidence in physical health care. This tool has been used in the United Kingdom and Australia; however, it has not been used in Canada.

Aim: This study aims to modify and provide an initial psychometric evaluation of the PHASe tool for use in a Canadian mental health and addictions context.

Methods: In Phase 1, clinical experts (n?=?8) were consulted to provide feedback on the content and face validity of the PHASe tool. In Phase 2, the PHASe tool was piloted with nurses at a large urban mental health and addiction organization in Ontario, Canada (n?=?77).

Results: In Phase 1, 4 items were added and 5 items were removed from the tool based on feedback provided by experts. In Phase 2, 12 poorly correlated items were removed. A two-factor solution was identified, with subscales “confidence” and “barriers and attitudes”.

Discussion: Initial psychometric evaluation suggests that a revised 15-item version of the PHASe tool is valid and reliable in a Canadian mental health and addictions context; however, more testing is recommended in larger, more diverse samples.     

Mental health nursing and physical health care: A cross‐sectional study of nurses' attitudes,practice, and perceived training needs for the physical health care of people with severe mental illness

Mental health nurses have a key role in improving the physical health of people with a serious mental illness, however, there have been few studies of their attitudes or the extent of their involvement in this work. The aim of this study was to examine mental health nurses' attitudes to physical health care and explore associations with their practice and training. A postal questionnaire survey including the Physical Health Attitude Scale for mental health nurses (PHASe) was used within a UK mental health trust. The 52% (n = 585) of staff who responded reported varying levels of physical health practice; this most frequently involved providing dietary and exercise advice and less frequently included advice regarding cancer screening and smoking cessation. Having received post‐registration physical health‐care training and working in inpatient settings was associated with greater reported involvement. More positive attitudes were also evident for nurses who had attended post‐registration physical health training or had an additional adult/general nursing qualification. Overall, the attitudes of mental health nurses towards physical health care appear positive and the willingness of nurses to take on these roles needs to be recognized. However, there are areas where nurses in our sample were more ambivalent such as cancer screening and smoking cessation.     

Nursing attitudes towards acute mental health care: development of a measurement tool

AIM: This paper reports the development, piloting and validation of a tool to measure attitudes for use with nursing staff working in acute mental health care units. BACKGROUND: The quality of care provided for service users in acute mental health care has come under both scrutiny and severe criticism. The attitudes of staff working in these environments have been cited as a contributory factor in poor care. No measure of attitudes specific to acute mental health has been reported. METHODS: A 64-question measure was constructed and distributed to a sample of qualified and unqualified nurses drawn from seven mental health care units in the North of England. Exploratory factor analysis and a number of other statistical tests were performed to validate the questionnaire. RESULTS: Preliminary analysis reduced the original 64 questions to 37. Five components were retained, accounting for 42% of the variance, and the five rotated factors were identified. The resultant 'Attitudes Towards Acute Mental Health Scale' (ATAMHS) achieved good internal reliability, with a Cronbach's alpha of 0.72. CONCLUSION: The construction and validation of the ATAMHS measure will enable improved understanding of the attitudes of nursing staff working in acute mental health care settings to occur. This measure is available for use in a clinical area of nursing in which attitude change is of fundamental importance for future development of care.     

Public health nurses’ views on quality measures: A cross-sectional study

BackgroundThe quality indicators program has intended and unintended consequences that may affect nurses’ professional performance and organisational outcomes.AimsTo explore public health nurses’ knowledge, attitudes, and perceptions of the nursing-sensitive quality indicators applied in mother–child health clinics and their associations with organisational quality outcomes: quality of care, burnout, and communication.MethodsA cross-sectional study with a convenience sample. In total, 177 public health nurses completed a self-administered questionnaire measuring their knowledge, attitudes, and perceptions of the quality indicators regarding their performance and organisational outcomes. A structural equation modelling analysis was performed to describe the associations between the variables and to identify the mediating variables.FindingsThe structural equation modelling analysis revealed that the intended (positive) impact on the nurse's professional level was the mediating variable between the nurses’ knowledge and attitudes towards the National Health Quality Measure program, their seniority, and the unintended (negative) impact on the nurse's professional level, and the organisational outcomes.Discussion and conclusionPublic health nurses perceive quality indicators as contributing to and improving their professional work, with a positive impact on organisational outcomes. Nursing leaders and policymakers may promote good organisational outcomes by developing methods that will emphasise the importance of quality indicators in nursing practice.     

Mental health nurses’ emotions,exposure to patient aggression,attitudes to and use of coercive measures: Cross sectional questionnaire survey

BackgroundMental health nurses are exposed to patient aggression, and required to manage and de-escalate aggressive incidents; coercive measures such as restraint and seclusion should only be used as a last resort. An improved understanding of links between nurses’ exposure to aggression, attitudes to, and actual involvement in, coercive measures, and their emotions (anger, guilt, fear, fatigue, sadness), could inform preparation and education for prevention and management of violence.ObjectivesTo identify relationships between mental health nurses’ exposure to patient aggression, their emotions, their attitudes towards coercive containment measures, and their involvement in incidents involving seclusion and restraint.DesignCross-sectional, correlational, observational study.SettingsLow and medium secure wards for men and women with mental disorder in three secure mental health hospitals in England.ParticipantsN = Sixty eight mental health nurses who were designated keyworkers for patients enrolled into a related study.MethodsParticipants completed a questionnaire battery comprising measures of their exposure to various types of aggression, their attitudes towards seclusion and restraint, and their emotions. Information about their involvement in restraint and/or restraint plus seclusion incidents was gathered for the three-month period pre- and post- their participation. Linear and logistic regression analyses were performed to test study hypotheses.ResultsNurses who reported greater exposure to a related set of aggressive behaviours, mostly verbal in nature, which seemed personally derogatory, targeted, or humiliating, also reported higher levels of anger-related provocation. Exposure to mild and severe physical aggression was unrelated to nurses’ emotions. Nurses’ reported anger was significantly positively correlated with their endorsement of restraint as a management technique, but not with their actual involvement in restraint episodes. Significant differences in scores related to anger and fatigue, and to fatigue and guilt, between those involved/not involved in physical restraint and in physical restraint plus seclusion respectively were detected. In regression analyses, models comprising significant variables, but not the variables themselves, predicted involvement/non-involvement in coercive measures.ConclusionsVerbal aggression which appears targeted, demeaning or humiliating is associated with higher experienced anger provocation. Nurses may benefit from interventions which aim to improve their skills and coping strategies for dealing with this specific aggressive behaviour. Nurse-reported anger predicted approval of coercive violence management interventions; this may have implications for staff deployment and support. However, anger did not predict actual involvement in such incidents. Possible explanations are that nurses experiencing anger are sufficiently self-aware to avoid involvement or that teams are successful in supporting colleagues who they perceive to be ‘at risk’. Future research priorities are considered.     

Improving the physical health of people with severe mental illness in a low secure forensic unit: An uncontrolled evaluation study of staff training and physical health care plans

The life expectancy of people with severe mental illnesses is substantially reduced, and monitoring and screening for physical health problems is a key part of addressing this health inequality. Inpatient admission presents a window of opportunity for this health‐care activity. The present study was conducted in a forensic mental health unit in England. A personal physical health plan incorporating clearly‐presented and easily‐understood values and targets for health status in different domains was developed. Alongside this, a brief physical education session was delivered to health‐care staff (n = 63). Printed learning materials and pedometers and paper tape measures were also provided. The impact was evaluated by a single‐group pretest post‐test design; follow‐up measures were 4 months’ post‐intervention. The feasibility and acceptability of personal health plans and associated resources were examined by free‐text questionnaire responses. Fifty‐seven staff provided measures of attitudes and knowledge before training and implementation of the physical health plans. Matched‐pairs analysis indicated a modest but statistically‐significant improvement in staff knowledge scores and attitudes to involvement in physical health care. Qualitative feedback indicated limited uptake of the care plans and perceived need for additional support for better adoption of this initiative. Inpatient admission is a key setting for assessing physical health and promoting improved management of health problems. Staff training and purpose‐designed personalized care plans hold potential to improve practice and outcomes in this area, but further support for such innovations appears necessary for their uptake in inpatient mental health settings.     

Safety attitudes,perceived organizational culture and knowledge of the physiologically deteriorating patient among mental health nurses: Cross‐sectional,correlational study

Mental health nurses have traditionally lagged in terms of physical healthcare skills and have been found to have poorer cultural safety‐related attitudes relative to other nurses. Organizational culture, including safety‐related culture, is associated with important aspects of care quality. The aim of the current study was to examine the relationships between safety‐related attitudes, physical healthcare‐related knowledge and organizational culture among mental health nurses. By doing so, the intention was to inform decisions about interventions to improve attitudes and care related to severe physiological deterioration among mental health nurses. The study design was cross‐sectional and correlational. The safety‐related attitudes of N = 133 nurses from the inpatient mental health services of one Local Health District in New South Wales, Australia, were examined in terms of a range of potential predictor variables of safety attitudes (Safety Attitudes Questionnaire) including individual organizational‐perceiver type (Organisational Climate Assessment Inventory), knowledge of emergency medical healthcare (Lambeth In situ Training Questionnaire), use and perception of medical emergency teams (purpose‐designed questionnaire) and a range of demographic variables. Regression analyses revealed that those who perceived the organization to have a primarily market‐oriented culture had poorer safety‐related attitudes than those who perceived a more clan‐type culture. Number of years qualified was negatively associated with safety attitudes. To our knowledge, this is the first study in mental health which demonstrates a link between organizational culture‐perception and safety attitudes related to physical healthcare. Results suggest that, among nurses, individuals have quite different perceptions of the organizational culture. In turn, this suggests that the ‘one‐size fits all’ approach to changing organizational culture may be inappropriate.     

Measuring the violence prevention climate: Development and evaluation of the VPC-14

BackgroundViolence and aggression are common in inpatient mental health hospital settings and cause problems for staff, patients and organisations. An important factor in treatment efficacy is ward atmosphere, and one element of this is the violence prevention climate.ObjectivesTo develop and test the psychometric properties of a new scale to measure perceptions of the violence prevention climate among staff and patients in mental health inpatient settings.DesignScale development and cross-sectional validation study. Setting and participants: Three hospital sites within an independent sector provider of secure mental health care. Participants were patients and staff residing in/working on wards in the adult male and female mental health care pathways.MethodsThe study was conducted in three stages: scale development, pilot testing and psychometric evaluation. The scale items were developed from systematic literature review, informant interviews (staff) and focus groups (patients) and expert review. The resulting scale was subject to pilot testing with staff and patients (n = 58 and n = 25). The reliability and validity of the scale was examined by administering it to 326 staff and 95 patients. Exploratory factor analysis was used to establish construct validity, and this was further assessed with Rasch modelling. Internal consistency was assessed by calculation of Cronbach's alpha coefficients. Convergent and discriminant validity were measured by comparing results with existing validated instruments. Temporal stability of the items was assessed using test-retest reliability coefficients.ResultsThe VPC-14 is a 14-item scale demonstrating good psychometric properties. Exploratory factor analysis revealed two subscales, staff actions and patient actions, each demonstrating good internal consistency (Cronbach's alpha .89 and .76). All items demonstrated good temporal stability. Rasch modelling confirmed the unidimensionality of the two subscales, and items demonstrated high construct validity. Moderate correlations were found between subscales of the VPC-14 and the EssenCES, whilst no correlations were found with items in the ACMQ, thus demonstrating good convergent and discriminant validity.ConclusionThe VPC-14 is currently the most robust available measure of the inpatient violence prevention climate. It is quick and easy to administer, considers views of both staff and patients and thus can be introduced as standard practice in a ward setting. Potential uses include tracking the violence prevention climate longitudinally and in evaluation of new policy and procedural interventions.     

Factors influencing nurses' attitudes towards the use of computerized health information systems in Kuwaiti hospitals

Title. Factors influencing nurses’ attitudes towards the use of computerized health information systems in Kuwaiti hospitals Aim. This paper reports a survey of nurses’ attitudes towards computerized health information systems, the characteristics that influence these attitudes and the level of nurses’ skills in computer use. Background. The use of such systems in developed countries and in some developing countries has already become a reality. However, nurses as a group of care providers have been found to resist computerization, seeing computerized health information systems as dehumanizing, confusing and uncaring. Nurses with more computer experience tend to have more positive views; education and training positively influence attitudes; and younger and less experienced nurses may have more positive attitudes. Methods. A structured questionnaire was used to measure the attitudes of nurses working in Kuwait towards computerization. A random sample of 574 nurses working in Ministry of Health hospitals were sent a questionnaire, and 530 replies were received (response rate 92·3%). The data were collected from November 2002 to January 2003. Findings. Respondents generally had positive attitudes toward computerized health information systems. Analysis of variance revealed statistically significant differences in attitudes in relation to nationality, level of education, previous experience in computer use, and computer skills (P < 0·05). Multiple regression analysis showed that gender, nationality, education levels, and duration of computer use were statistically significant predictors of attitudes toward computerized health information systems (P < 0·05). Conclusion. With adequate computerized health information system training, the implementation of computerized health information systems could be effective for nurses in providing quality health care, as found in other studies.     

Emergency nurses’ perceptions of the health care system and how it impacts provision of care to people who self-harm

BackgroundSelf-harm is a deliberate act to cause physical harm to oneself. People who self-harm are at greater risk for suicide than people who do not self-harm. Emergency nurses are first responders to many people who present to the emergency department (ED) with self-harm. The care they provide can influence future presentations to the emergency department and long-term outcomes.AimThe aim was to explore ED nurses’ experiences of working with people who self-harm.MethodsSemi-structured interviews were conducted with 18 emergency nurses from different locations in Australia in 2019. Elo and Kyngäs’ inductive content analysis research method guided all stages of the research.ResultsThe category “health care system” emerged from the data. It comprised five subcategories: (i) Complexity of the work environment; (ii) ED staff attitudes and care provision; (iii) the mental health patient; (iv) facilitators and barriers to providing care to people who self-harm; and (v) lack of community resources.DiscussionThis study found there were several factors influencing ED nurses’ knowledge, skills and confidence in caring for people who self-harm and several factors influenced their experience.ConclusionWhile participants felt confident to manage the physical injuries associated with self-harm, they were less confident to engage with the person about their self-harm. The article provides guidance for ED nurses to assess and intervene with people who present with self-harm.     

Death and the health professional: Organization and defense in health care

Abstract

Organizational and technological developments within the health care system have helped consolidate a power structure that dehumanizes clients and fosters defensive-ness in professionals. Frequent exposure to death renders health professionals vulnerable to severe anxiety, which they may try to avoid through death denial, leaving them psychologically unable to support dying clients. Professional education, attitudes equating death with professional failure, organizational coping strategies among nurses, and staff burnout interact to perpetuate this atmosphere. As a model for learning, this article analyzes a pediatric case study to illuminate the manifestations of professional defensiveness. Finally, I consider three specific problem-solving strategies: improving morale, opening communication, and expanding professional education to include death studies and psychological study of the health organization. Bringing humanity back into the health care environment is possible to the extent that both the organization and its members are responsive and open to change.     

Quality of life and stress in mothers of preterm infant with feeding problems: A cross sectional study

BackgroundThe majority of preterm infants experience some oral feeding problems. The outcomes of preterm infants with feeding problems are not predictable. This study was conducted to determine the quality of life and stress among mothers of preterm infants with feeding problems.Materials and methodsParticipants consisted of mothers with preterm infants. The instruments used to measure infants' feedings, mothers' stress and quality of life, and mothers' and infants’ characteristics included: Infants Feeding Readiness Assessment Scale (POFRAS), Parental Stress Scale: Neonate Intensive Care Unit (PSS - NICU), quality of life questionnaire (SF-36), and a socio-demographic questionnaire.ResultsThere was no correlation between the subscales of the PSS - NICU and the POFRAS or between domains of SF-36 and POFRAS. There was no significant association between general physical health and stress. However, general mental health and overall quality of life of mothers were inversely correlated with all PSS-NICU subscales.ConclusionMost maternal stress was related to the infants' appearance and behaviors. The mental health dimension was affected more than the physical health dimension of quality of life. Health care professionals should teach mothers of premature infants about the NICU environment, parental role, and their infants’ appearance and behaviors.     

Patients’ Perceptions of What Makes a Good Doctor and Nurse in an Israeli Mental Health Hospital

The aim of this study was to identify inpatients’ expectations of their doctors and nurses in a mental health hospital setting. Individual interviews were conducted with 72 inpatients of a large mental health hospital in northern Israel. Our study produced three major results. First, most patients, whatever their emotional status, share similar expectations of staff, of which the most conspicuous is that they be respected as whole persons and that staff not treat them merely as cases of illness. Second, they expect to be involved in making decisions about their treatment, including being informed of reports and records referring to them. Third, patients expect all hospital staff, particularly nurses, to provide them with emotional support. The findings of this study can be used to facilitate improved care of mental health inpatients by both doctors and nurses. Structured and methodical examinations of inpatients’ expectations at the time they are hospitalized can help adjust not only the professional aspect of health care but also the therapeutic communication approach to patients’ individual needs.     

Sexuality and Consumers of Mental Health Services: The Impact of Gender and Boundary Issues

The importance of sexuality to humanity is clearly acknowledged. However, for consumers of mental health services, it tends to be a neglected topic. Although nurses are at the forefront of mental health service delivery, evidence suggests they are reluctant to include sexuality as part of their care. This article describes the findings from a qualitative exploratory research project that examined mental health nurses’ attitudes to discussing sexuality with consumers. Fourteen mental health nurses from a service in Queensland participated in this study. Data analysis revealed two main themes: the impact of gender, and professional boundary issues. In terms of gender, participants referred to the impact of sexual dysfunction experienced by young adult male consumers. For female consumers the discussion centred on vulnerability to sexual exploitation and the need to exercise protective measures to ensure safety. Participants indicated concerns about being professionally compromised when discussing sexuality with consumers of the opposite sex. These findings highlight the need for further exploration of mental health nurses’ attitudes towards discussing sexuality with consumers as part of their practice.     

Forensic mental health: Perceptions of transition and workforce experiences of nurses

BackgroundWith the growing need for nurses in forensic mental health settings, understanding the experiences of transition and perceptions of the setting is important to support staff retention.AimTo explore registered nurses’ experiences of working in a forensic mental health setting. In particular, to understand their transition experience, perceptions of the practice environment and intention to stay within the setting.MethodsRegistered nurses employed in a high-secure forensic mental health hospital in New South Wales, Australia, completed an online survey including the Revised Professional Practice Environment Scale and Nurse Retention Index.FindingsSixty-nine participants responded to the survey. During the first year of their employment, participants reported feeling isolated, lacking support and being anxious when providing patient care. In terms of the environment, participants perceived ‘internal work motivation’ as positive in the environment when compared to ‘handling disagreement and conflict’. While many intended to continue their nursing careers for the foreseeable future, 45.3% of participants were undecided about whether they would leave the forensic setting.DiscussionDue to the complexity of forensic mental health practice, the reporting of poor experiences of transition and issues regarding support and conflict is concerning. Considering the importance of workplace culture and teamwork in forensic mental health, strategies to enhance positive interpersonal relationships is essential.ConclusionGiven the predicted future workforce shortages, this study highlights a need for appropriate supports for nurses’ transitioning into forensic mental health employment to enhance workplace satisfaction and retention.     

District nursing staff and depression: a psychometric evaluation of Depression Attitude Questionnaire findings

BACKGROUND: Mental health problems such as depression are common in primary care settings and patients with chronic medical problems are at an increased risk. This co-morbidity suggests that district nursing services are particularly likely to encounter psychological problems in their patients. Mental health problems are poorly recognised and inadequately treated in primary care. In part this may be due to stigmatising views of mental illness, which negatively influence help-seeking and user experiences. Likewise providers' attitudes are likely to play a significant part in the management of such problems. OBJECTIVES: The aims of this study were extend knowledge of district nursing staff attitudes to depression and explore the psychometric properties of a depression attitude measure used with this staff group. DESIGN AND SETTINGS: The Depression Attitude Questionnaire (DAQ) was used within a postal questionnaire survey of district nursing services in three areas, Jersey (Channel Islands), Lewisham, and Hertfordshire. PARTICIPANTS: All staff (community nurses, district nurses and home care staff) were contacted; 217 (66%) staff responded to the survey, and 189 (57%) completed the DAQ. RESULTS: Three factors were derived from the DAQ accounting for 47% of the variance. The factor solution appeared stable and provided meaningful dimensions, however the internal consistency of the measure and of its derived subscales was low (Cronbach's alpha between 0.59 and 0.64). The factors were labelled pessimism about depression and its treatment, tendency to defer to specialists, and professional ease in working with depressed patients. Staff responses revealed generally optimistic views concerning depression treatment, strongly rejecting deterministic attitudes to this condition. CONCLUSIONS: The DAQ has been widely employed to measure and compare attitudes of staff from various disciplines and specialisms. The current evaluation has provided a more detailed examination of its psychometric properties than previously available, but low internal consistency levels indicate further examination of this area is warranted.     

Mental health nurses’ attitudes towards consumer involvement in nursing handover pre and post an educational implementation

Involving mental health consumers in nursing handover is a recent introduction to practise in acute mental health units. However, implementation must recognize that mental health care is complex and the approach needs to include recovery‐focused philosophies of practice. Evidence shows that nurses and other health professionals consider poor handover practices may be the source of adverse events; however, the views of mental health nurses about involving consumers in nursing handover have not been previously reported. The aim of this study was to identify nurses’ attitudes towards consumer involvement in handover and to measure the effect of a training programme upon these attitudes. A single‐group pre‐post‐test intervention study was undertaken. The study was conducted on the adult acute mental health inpatient unit of a major metropolitan hospital in Victoria, Australia, 2016–2017. Questionnaires were developed to capture the views of the nurses about proposed changes in the afternoon nursing handover process. A questionnaire was administered before and after the training intervention, an innovative, multi‐media education handover package. We found that training had a significant influence on mental health nurses’ attitudes towards involving consumers in the handover. Therapeutic engagement improved following training and miscommunication reduced when all players are informed and have the opportunity to engage with the information. This study has demonstrated that well‐planned education can influence nurses’ attitudes about involving consumers in the nursing handover processes.     

Perceived barriers to providing spiritual care among psychiatric mental health nurses

BackgroundAlthough nurses typically view spiritual care as important, it is provided infrequently.ObjectivesThis research investigated psychiatric mental health nurses' perceived barriers to providing spiritual care, and how these barriers were associated with frequency of spiritual care and demographic factors.MethodsThis cross-sectional correlational study of 159 psychiatric mental health nurses used questionnaires to measure frequency of spiritual care and barriers to spiritual care.ResultsThe most frequent barriers to providing spiritual care were lack of education and fear of exacerbating psychiatric symptoms. Psychiatric mental health nurses provided spiritual care infrequently.ConclusionsNurses need education about providing spiritual care to those with psychiatric mental health needs.