Reactions of nurses and therapists in mainstream health services to contact with people who have learning disabilities

Government policy in the United Kingdom is to make the National Health Service accessible to all citizens, including those who hitherto may have relied on specialist services. It is recognized that the attitudes of health professionals can be a major influence in making this happen. To date there has been a paucity of research studies involving nurses and therapists, two of the largest groupings of health care workers. The present study contrasted the reactions of nurses and therapists to their contact with people who have learning disabilities, with those of staff working in specialist services for this client group, and with students who are not involved in health services. Over 1000 respondents - mainly university students on undergraduate or post-graduate courses - completed a written questionnaire. Although nurses and therapists had significantly less contact with people who had learning disabilities during their work than did staff in specialist services, there were no differences in terms of contact in personal life. In both instances their contacts were higher than those reported for non-healthcare students. However both nurses and therapists were significantly less confident in working with a patient who had learning disabilities as opposed to one with physical disabilities. By contrast, willingness for social contacts did not vary across the four groups although respondents with previous personal contact were significantly more willing for this than those with no prior contact. The results confirm that the form of contact is a more salient variable on staff attitudes than contact per se. Hence, changed reactions are more likely to come about from successful contacts in a work rather than social environment. The implications are discussed for initial and post-qualifying training courses, especially for suitable placement experiences. Suggestions are made for future research that focuses on increasing the expertise and confidence of nurses and therapists in working with patients who have learning disabilities.     

Attitudes toward people with disabilities: a comparison between health care professionals and students

The objective of this study was to explore the attitudes of health care professionals and their students towards people in Hong Kong with disabilities. The attitudes of four groups of professionals and students (physiotherapists, occupational therapists, social workers and nurses) were assessed using the well-documented Attitude Toward Disabled Persons scale through the methodology of mailed questionnaires. Comparisons were made among different groups of students and professionals in order to gain insight into factors affecting their behavior. In this study, 511 students and 489 professionals were selected randomly. The results indicated that the overall mean Attitude Toward Disabled Persons scale score of the respondents was comparatively lower than that of their counterparts in foreign countries. The professionals had a significantly higher attitudinal score than the students. Among the four disciplines, nurses held the least favorable attitudes towards people with disabilities. In addition, their attitudes were less positive than those of the student nurses. On the other hand, the social work students had less favorable attitudes than the professional social workers, as well as other types of health care students. The analysis of the data also revealed that the mean Attitude Toward Disabled Persons scale scores for both the occupational therapists and occupational therapy students were above the overall average. Unlike the physiotherapists, the mean Attitude Toward Disabled Persons scale score of the physiotherapy students was below the overall average. In addition, age, year of study, educational level, knowledge and contact with people with disabilities were significant factors in the attitudes held by the students and professional respondents. The quality of the contact was found to be a dominant factor in affecting the scores on attitude. Thus, recommendations were made to modify the current training curriculum and enhance the quality of services to develop more favorable attitudes towards people with disabilities.     

Attitudes towards people with physical or intellectual disabilities: nursing students and non‐nursing peers

Title. Attitudes towards people with physical or intellectual disabilities: nursing students and non‐nursing peers. Aim. This paper is a report of a study of the attitudes of Dutch nursing students towards people with physical or intellectual disabilities. Background. Attitudes of healthcare professionals are a major factor in the rehabilitation and self‐acceptance of persons with disabilities. Consequently, it is important that nurses develop or maintain positive attitudes towards people with disabilities during their education. However, more knowledge is needed about current attitudes of nursing students and factors influencing these attitudes. Methods. A sample of Dutch nursing students (n = 81) and an age‐matched group of non‐nursing peers (n = 48) completed standardized scales measuring attitudes about physically or intellectually disabled people. Data were collected in 2006. Findings. Nursing students were more positive towards physically disabled people than their peers, and more strongly endorsed empowerment and similarity of intellectually disabled people. These attitudinal differences generally remained statistically significant after multivariate adjustment for demographic variables and experience and contact with individuals with disabilities. An important independent determinant of a positive attitude towards physically disabled people in the total sample was having a relative or friend with a physical disability. This association, however, was not apparent in attitudes towards intellectually disabled persons. Conclusion. Educational interventions aimed at improving attitudes towards people with disabilities should include focus on forms of contact beyond the context of formal care relationships.     

Learning disabilities: a survey of community nurses for people with prevalence of challenging behaviour and contact demands

Background. There is scant knowledge on the contacts community nurses for people with learning disabilities have with clients who display challenging behaviours, or the numbers of such people on these nurses‘ caseloads. This study was undertaken in a UK region with a population of 1.68 million people. In this region it is estimated that there are 8500 people with learning disabilities who are in contact with services, this includes around 500 people remaining in hospitals awaiting resettlement. Aims and objectives. The research aims were to identify the overall caseload sizes of the nurses, the prevalence of people with learning disabilities who have challenging behaviours on the nurses’ caseloads and what contact demands these people required. An additional aim was to discover courses or training that helped the nurses to fulfill their roles. Design and methods. A postal survey was undertaken of the total population of community nurses for people with learning disabilities in the region. The method of data collection was a self‐completion questionnaire. Results. The study found that people with challenging behaviours accounted for over a quarter of the combined caseloads, and these clients required the most frequent visits from the nurses. There was a wide range in the number of clients on the caseloads of each nurse but overall these were higher than in other parts of the UK. Conclusions. It is concluded that community nurses for people with learning disabilities have large caseloads and people with learning disabilities who have challenging behaviours, who account for over one‐quarter of the clients they visit, require much more frequent contact visits than other clients. The combination of high numbers of clients (or low numbers of these nurses) may impact on how such nurses are able to perform their role and functions. Relevance to clinical practice. An increase in the numbers of community nurses for people with learning disabilities and skill development in caring for people with challenging behaviours is recommended. If this is not performed the clinical effectiveness of this group of nurses with respect to their work with people who challenge services may be unduly hampered.     

Responding to people with a learning disability who offend

AIM: This article reports on a small survey conducted in one NHS trust to establish the number of people with a learning disability known by staff to have committed, or be alleged to have committed, an offence. METHOD: A sample of 35 members of staff who were likely to be in contact with this client group were sent questionnaires. Thirty responses were received, giving a response rate of 86 per cent. RESULTS: A total of four nurses and two clinical psychologists were in contact with 31 individuals known or alleged to have committed an offence. These offences were mainly sexual and some were violent. Several individuals had committed a number of separate offences. Respondents felt that the needs of these individuals were not adequately met by current service provision. CONCLUSION: A planned inter-agency response is required to deal with people with learning disabilities who carry out criminal offences, rather than the current system which is vague in terms of allocating responsibility for action. The nurse's role in providing sexual health education for those with learning disabilities also needs to be considered in the light of the survey results.     

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.     

Attitudes of nurse professionals and nursing students towards children with disabilities. Do nurses really overcome children's physical and mental handicaps?

Background:  Many health professionals and nurses, who are involved in the care of disabled children, do not exhibit the essential sensitivity and appropriate attitudes towards them, resulting in a poor quality of nursing care.
Aim:  The objective of this study was to investigate the attitudes of nurse professionals (paediatric nurses) and nursing students towards disabled children.
Patients and methods:  The present study is a comparative study. The sample consisted of 228 first-year nursing students, 90 post-diploma nurses attending MSc degree course and 123 nurse professionals who are employed in paediatric hospitals. After obtaining permission from the hospitals and the educational settings and informing about the subjects of the study, data were collected using the paediatric Attitude Towards Disabled Person Scale (ATDP).
Results:  Overall nurses' attitudes appeared to be poor (mean ATDP score 61.7 ± 14.2). However, the post-diploma nurses had significantly higher ATDP scores than first-year students and paediatric nurses ( P  < 0.001). In addition, first-year students had significantly higher scores than paediatric nurses ( P  = 0.047). Across the sample, females hold significantly more positive attitudes than males ( F  = 9.5, P  = 0.002), while age did not have any significant effect.
Conclusions:  Carefully designed curricula can influence the attitudes of nursing students towards children with disabilities. Special courses for treating disabled children should be integrated to the basic nursing studies. Moreover, continuing hospital education can change paediatric nurses' attitudes towards children with disabilities.     

Children’s contact with people with disabilities and their attitudes towards disability: a cross-sectional study

Purpose: To explore the association between children’s self-reported contact with people with disabilities and attitudes towards them, as well the potential mediating influence of anxiety about interacting with people with disabilities and empathy for them. Method: 1881 children, aged 7–16 years, from 20 schools in South West England completed a survey assessing their contact with people with disabilities and their attitudes towards them. Anxiety about interacting with people with disabilities and empathy towards them were examined as potential mediators. Gender, school year, perceived similarity between people with and without disabilities, proportion of children with additional needs at the school and socioeconomic status (SES) were assessed as moderators. A random effects (“multilevel”) regression model was used to test the contact–attitude association and moderation, and path analysis was used to test for mediation. Results: Participants with more self-reported contact reported more positive attitudes towards disability (p?Conclusions: Self-reported contact was observed to be associated with more positive attitudes towards disability, which was partially mediated by empathy and anxiety. Providing opportunities for contact with people with disabilities that reduces anxiety and increases empathy may improve attitudes to disability and merits evaluation in interventions.

• Implications for Rehabilitation

• Children who reported greater levels of contact with people with disabilities had more positive attitudes towards disability.

• Anxiety about interacting with people with disabilities and empathy towards them partially mediated the contact–attitude associations.

• Providing opportunities for contact with people with disabilities, reducing anxiety and increasing empathy may improve children’s attitudes to disability.

     

Nurses'' attitudes towards a patient who has a psychiatric history

This study was carried out in a large Metropolitan General Hospital in New York, USA. The aim of the study was to determine the differences in nurses' attitudes towards a general hospital patient who had, or had not, a previous psychiatric illness. One hundred and twenty-eight graduate (trained) nurses were asked to read the patient's case notes, to view videotapes and to answer questionnaires as part of the research method. Analysis of the data obtained demonstrates the statistically significant finding below the 0·02 level that the nurses' attitudes were generally more negative towards the former psychiatric patient. In several instances, the disturbed behaviour of the patient was more significant than the patient's previous hospitalization: the findings also suggest that the graduate nurses equate mental illness with organic causes.
The study poses many questions for nurse educators, but particularly for those responsible for psychiatric nursing education.     

The Effect of Prior Experience in a Rehabilitation Setting on Students' Attitudes Toward the Disabled

The attitudes and reactions of rehabilitation nurses and nursing students toward patients with disabilities are important to the patients' adjustment and care over time. The purpose of this research study was to examine the effect of prior work experience and clinical experience in a rehabilitation setting on students' attitudes toward the disabled. The study involved the administration of Yuker, Block, and Young's (1966) Attitudes Toward Disabled Persons Scale (ATDP). Nursing students (N = 225) appropriately completed the ATDP before and I month after attending an educational workshop on care of people with disabilities. Prior work experience with such people was found to have a significant impact on student attitudes. Subjects with prior work experience in a rehabilitation setting had significantly higher scores on the ATDP, indicating more positive attitudes toward people with disabilities, than did subjects without this experience. Students who had clinical experience in a rehabilitation setting had higher scores on the ATDP than students without it, but the difference was not statistically significant.     

Are You Positive?: AIDS, Attitudes and Physiotherapy

This study was conducted to find out the attitudes of chartered physiotherapists towards people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). A convenience sample of 144 chartered physiotherapists of all grades from nine institutions in the United Kingdom was used in the study. The physiotherapists were surveyed using a self-completion postal questionnaire. The attitude scores were generally high indicating positive attitudes towards people with HIV and AIDS. Statistical analysis using t-tests and ANOVA showed that women were found to have more positive attitudes than men. There were differing attitudes according to age, with those aged 40 plus having less positive attitudes than those aged 39 and under. Those respondents who had worked with people with HIV and AIDS had significantly more positive attitudes than those who had not worked with this client group. Surprisingly, there was no significant difference in attitudes between those who had had training in HIV and AIDS and those who had not. Finally, whether the region was one of high or low prevalence had an effect on attitudes, with those in high prevalence areas having significantly more positive attitudes. The level of significance used in this study was p = > 0.05.     

Enabling or disabling? Students' attitudes toward persons with disabilities.

Persons with disabilities are devalued by society. Occupational therapists may be contributing to this devaluation through their attitudes. This study focused on the attitudes of undergraduate students. From a sample of 223 occupational therapy students and 326 business students at an Australian university, it was found, with the use of the Attitudes Toward Disabled Persons Scale-Form A (Yuker, Block, & Young, 1966), that the attitudes of freshman occupational therapy students did not differ significantly from those of their business-major peers. Furthermore, the occupational therapy students' attitudes did not vary with the years of undergraduate education completed. However, those students who had had contact with persons with disabilities beyond the context of a caregiver-care receiver relationship (i.e., those students who had assumed roles that emphasized valued attributes of the person with a disability) had significantly more positive attitudes than did those students without such contact. Educational curricula must address the issue of students' attitudes and, in particular, the facilitation of valued social role contact with persons with disabilities.     

Interventions to improve mental health nurses’ skills,attitudes, and knowledge related to people with a diagnosis of borderline personality disorder: Systematic review

ObjectivesThere is some evidence that mental health nurses have poor attitudes towards people with a diagnosis of borderline personality disorder and that this might impact negatively on the development of helpful therapeutic relationships. We aimed to collate the current evidence about interventions that have been devised to improve the responses of mental health nurses towards this group of people.DesignSystematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement.Data sourcesComprehensive terms were used to search CINAHL, PsycINFO, Medline, Biomedical Reference Collection: Comprehensive, Web of Science, ASSIA, Cochrane Library, EMBASE, ProQuest [including Dissertations/Theses], and Google Scholar for relevant studies.Review methodsIncluded studies were those that described an intervention whose aim was to improve attitudes towards, knowledge about or responses to people with a diagnosis of borderline personality disorder. The sample described had to include mental health nurses. Information about study characteristics, intervention content and mode of delivery was extracted. Study quality was assessed, and effect sizes of interventions and potential moderators of those interventions were extracted and converted to Cohen's d to aid comparison.ResultsThe search strategy yielded a total of eight studies, half of which were judged to be methodologically weak with the remaining four studies judged to be of moderate quality. Only one study employed a control group. The largest effect sizes were found for changes related to cognitive attitudes including knowledge; smaller effect sizes were found in relation to changes in affective outcomes. Self-reported behavioural change in the form of increased use of components of Dialectical Behaviour Therapy following training in this treatment was associated with moderate effect sizes. The largest effect sizes were found among those with poorer baseline attitudes and without previous training about borderline personality disorder.ConclusionsThere is a dearth of high quality evidence about the attitudes of mental health nurses towards people with a diagnosis of borderline personality disorder. This is an important gap since nurses hold the poorest attitudes of professional disciplines involved in the care of this group. Further work is needed to ascertain the most effective elements of training programmes; this should involve trials of interventions in samples that are compared against adequately matched control groups.     

Dentists’ attitude to provision of care for people with learning disabilities in Udaipur,India

Scand J Caring Sci; 2013; 27; 57–62 Dentists’ attitude to provision of care for people with learning disabilities in Udaipur, India This study determines and compares the attitudes of dentists to the provision of care for people with learning disabilities according to gender, qualification, previous experience of treating patients with learning disabilities and work experience of dentists. A cross‐sectional study was conducted among 247 dentists (166 men and 81 women) using a pretested structured questionnaire. This questionnaire assessed the respondent’s attitude towards learning‐disabled patients in five categories: beliefs about treating them, their capabilities, discrimination against these patients, their social behaviour and quality of care to be received by these patients. The information on dentist’s gender, qualification, work experience and previous experience of treating patients with learning disabilities was also collected through questionnaire. The Student’s t‐test and anova test were used for statistical analysis. The mean attitude score was found to be 71.13 ± 8.97. A statistically significant difference was found in the mean attitude scores of dentists with work experience (p = 0.000). Study subjects with postgraduate qualification and previous experience of treating patients with learning disabilities had significantly greater mean attitude score than their counterparts (p = 0.000). The overall attitude of dentists towards provision of care for people with learning disabilities was favourable, which increased with higher qualification and past experience.     

The role of community nurses for people with learning disabilities: working with people who challenge

The locus of care for people with learning disabilities has transferred from institutional to community-based services. Increasingly people who have learning disabilities and additional challenging behaviours live in community settings. Spearheading the care for these people are community nurses for people with learning disabilities. This study aimed to explicate the role of these nurses in their day-to-day work with people who challenge. Using grounded theory methodology, 22 nurses were selected by theoretical sampling and interviewed. An analytical story and theoretical framework that emerged from the grounded data is presented. It is suggested that this framework has utility for practice.     

Estimating the prevalence of negative attitudes towards people with disability: a comparison of direct questioning,projective questioning and randomised response

Purpose.?Despite being susceptible to social desirability bias, attitudes towards people with disabilities are traditionally assessed via self-report. We investigated two methods presumably providing more valid prevalence estimates of sensitive attitudes than direct questioning (DQ). Most people projective questioning (MPPQ) attempts to reduce bias by asking interviewees to estimate the number of other people holding a sensitive attribute, rather than confirming or denying the attribute for themselves. The randomised-response technique (RRT) tries to reduce bias by assuring confidentiality through a random scrambling of the respondent's answers.

Method.?We assessed negative attitudes towards people with physical and mental disability via MPPQ, RRT and DQ to compare the resulting estimates.

Results.?The MPPQ estimates exceeded the DQ estimates. Employing a cheating-detection extension of the RRT, we determined the proportion of respondents disregarding the RRT instructions and computed an upper bound for the prevalence of negative attitudes. MPPQ estimates exceeded this upper bound and were thus shown to overestimate the prevalence. Furthermore, we found more negative attitudes towards people with mental disabilities than those with physical disabilities in all three questioning conditions.

Conclusions.?We recommend employing the cheating-detection variant of the RRT to gain additional insight in future studies on attitudes towards people with disabilities.     

Nurse characteristics and attitudes to active voluntary euthanasia: a survey in the Australian Capital Territory

While surveys of Australian nurses' attitudes to active voluntary euthanasia (AVE) have found that the majority are in favour, there may be important differences between subgroups of nurses. This paper investigates the role of the following nurse characteristics on nurses' attitudes to AVE: age, gender, religion, amount of contact with terminally ill patients, area of specialty, and degree of interest taken in the issue of AVE. A postal survey on AVE was carried out in late 1996 of 2000 randomly selected registered nurses from the Australian Capital Territory. Responses were received from 1218 nurses (61%). The survey included a question asking whether the law should be changed to allow doctors to take active steps to bring about a patient's death under some circumstances. Overall, 69% of respondents agreed that the law should be changed. Those nurses who were more likely to agree were under the age of 40 years, agnostic, atheist or of the Anglican religion, to have less contact with terminally ill patients, to work in the area of critical care or mental health, and to take less interest in the issue of AVE. Palliative care nurses were the only subgroup without a majority in favour (33%). There is other evidence in the euthanasia literature, that nurses and doctors are less in favour of AVE than the general public. Taken together with the present findings, it can be concluded that attitudes towards AVE are more favourable in people who have less contact with the terminally ill.     

Effects of cognitive modeling,affect, and contact on attitudes,thoughts, and feelings toward college students with physical disabilities

One goal of the present study was to evaluate cognitive and affective factors which facilitate problem-free interaction between nondisabled and physically disabled college students by (1) exploring variables related to ease with people who have disabilities, and (2) evaluating the consequences of previous contact with disabled persons. A second goal was to explore the effects of four cognitive modeling interventions on thoughts, attitudes, affect, and self-efficacy expectations in relation to interaction with disabled peers. Results for 126 nondisabled college students indicate that lack of ease with persons who have disabilities is an important contributor to interaction difficulties; individuals who felt ill at ease with disabled college students (1) were more likely to anticipate being uncomfortable when interacting with a peer who has a disability, (2) had lower self-efficacy expectations about interacting in various social situations, (3) had more negative attitudes toward disabled persons, (4) expected to have more difficulty working with a disabled peer, and (5) had more negative thoughts about interacting with a disabled classmate. Previous contact with people who have disabilities was related to the frequency of positive thoughts about interaction but had minimal effects on attitudes or affect. Cognitive modeling was found to be ineffective in changing any aspect of these affective, attitudinal, and cognitive factors. The implications of the results for cognitive assessment and for resolving interaction problems between nondisabled and disabled individuals are discussed.

     

Student nurses' attitudes towards death and dying in south-east Iran

In this study, the attitudes of student nurses from Kerman and Bam in Iran towards death and caring for dying patients were compared. Two types of questionnaire were used: the DAP-R (Death Attitude Profile Revised) and FATCOD (Frommelt Attitude Towards Caring for Dying patients). The Bam student nurses, who had more experience of death due to the Bam earthquake in December 2003, were found to be less afraid of death and also less likely to give care to people at the end of life compared to their counterparts in Kerman. In both groups, those who were educated about death and dying had more positive attitudes towards caring for people who are dying than non-educated participants. The study suggests that adding palliative care education, accompanied by a reflective narrative approach, to the nursing curriculum is necessary to improve quality of care at the end of life.