General hospital health professionals’ attitudes and perceived dangerousness towards patients with comorbid mental and physical health conditions: Systematic review and meta‐analysis

The stigmatization of mental health is present in general hospital settings impacting quality of care. We hypothesized that health professionals in these areas would elicit negative attitudes and a perceived level of dangerousness across a range of mental health disorders. We aimed to conduct a systematic review and meta‐analysis to examine these attitudes and perceptions. We searched the bibliographic databases of CINAHL Complete, MEDLINE Complete, PsycINFO, and Psychology and Behavioral Sciences Collection in May 2017 (no date parameters were set). Quantitative studies investigating generalist health professionals’ attitudes towards mental health conditions were selected. Initially, prevalence meta‐analyses were conducted to assess the extent of perceived danger, followed by a series of comparative meta‐analyses in which the perceived dangerousness of mental health conditions was compared. Of the 653 citations retrieved, eight studies met the inclusion criteria. The overall sample included 2548 health professionals. A majority of health professionals perceived patients with substance use disorder as dangerous 0.60 (95% CI: 0.32–0.88) when compared with patients who had an alcohol‐related disorder, schizophrenia, and depression. The results also indicated that a large proportion of staff perceived patients with a diagnosis of schizophrenia as dangerous 0.42 (95% CI: 0.33–0.52). Negative attitudes towards people experiencing mental illness in general hospital settings may be attributed to poor mental health literacy, skills and limited exposure, and social and cultural beliefs about mental illness. Ongoing professional development targeting mental health knowledge is recommended for health professionals working in general hospital settings.     

General practitioners' attitudes towards patients with disabilities: The need for training and support

Purpose.?Some general practitioners (GPs) report discomfort in caring for people with disabilities. These feelings may impede the provision of quality health care to these patients.

Method.?A cross-sectional survey interviewed 600 GPs in southeastern France and assessed their personal and professional characteristics, their attitudes and opinions towards people with disabilities, and their knowledge and practices in this field.

Results.?21.3% of the GP reported discomfort in treating people with mental impairments and 8.2% people with physical impairments. Discomfort with either type of impairment was more frequent among GPs who perceived frequent communication problems with persons with disabilities (p < 0.05) or who did not belong to a professional network (p < 0.10). GPs who reported less experience with the disabled patients (p < 0.05), no medical training about disabilities (p = 0.04), a lack of assistance during consultations (p = 0.02), and inadequate consultation time (p = 0.09) expressed more discomfort in caring for patients with mental impairments. GPs' discomfort was associated with their assessment of the patient's level of disability among patients with physical impairments (p = 0.01).

Conclusion.?This study suggests that substantial obstacles related to GPs' attitudes impede the delivery of quality health care to patients with disabilities and that GPs need more support and guidance in dealing with them. These results raise also the issue of adequate time and remuneration for consultations with these patients.     

Emergency department nurse's attitudes towards patients who self‐harm: A meta‐analysis

Self‐harm is a major challenge to public health. Emergency department (ED) nurses treat significant proportions of patients with self‐harm injuries, and positive therapeutic patient–nurse interactions are imperative to the physical and psychological outcome of this vulnerable patient group. Research, both nationally and internationally, suggests that treating those with self‐harm injuries is emotionally challenging, and ambivalence, powerlessness, and ineffectiveness are commonly manifested in negative attitudes towards these patients. Following the PRISMA guidelines, this systematic review with meta‐analyses examined the attitudes of ED nurses towards patients who self‐harm, based on currently available evidence. The following databases were searched: CINAHL complete; Medline complete; PsycARTICLES; PsycINFO; The Allied and Complementary Medicine Database; Health Source: Nursing/Academic Edition; PsycEXTRA; and Psychology and Behavioural Sciences Collection. Clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant reports to identify additional studies, were also searched. Five studies were included in the meta‐analysis. The Self‐Harm Antipathy Scale (SHAS) was used as an outcome in two studies appropriate for meta‐analysis. The Attitudes Towards Deliberate Self‐Harm Questionnaire (ADSHQ) scale was used as an outcome in three studies appropriate for meta‐analysis. Results demonstrated limited empathy and negativity towards patients who self‐harm, indicating a requirement for education and supervision of ED staff, where the SHAS or the ADSHQ can be used to monitor attitude change. Self‐harm educational content for ED staff should include areas of knowledge building including explanations and causes of self‐harm; range, forms, and functions of self‐harm; staff responses to self‐harm; assessment, management, and interventions; professional practice issues.     

Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: a review of the literature

The aim of this paper was to review the existing literature pertaining to stigma, negative attitudes and discrimination towards mental illness, specifically as viewed through the lens of the nursing profession. The results of the literature review were synthesized and analysed, and the major themes drawn from this were found to correspond with Schulze's model identifying three positions that healthcare workers may assume in relation to stigma of mental illness: 'stigmatizers', 'stigmatized' and 'de-stigmatizers'. In this paper, the nursing profession is examined from the perspectives of the first two major themes: the 'stigmatizers' and 'stigmatized'. Their primary sub-themes are identified and discussed: (1) Nurses as 'the stigmatizers': (a) nurses' attitudes in general medical settings towards patients with psychiatric illness and (b) psychiatric nurses; (2) Nurses as 'the stigmatized': (a) nurses who have mental illness and (b) stigma within the profession against psychiatric nurses and/or psychiatry in general. The secondary and tertiary sub-themes are also identified and reviewed.     

Attitudes towards people with mental illness: a cross-sectional study among nursing staff in psychiatric and somatic care

Stigma and discrimination have been identified as important obstacles to the integration of people with mental illness in society. In efforts to reduce stigma and discrimination, health professionals play an important role as they have frequent contact with and responsibility for treatment and rehabilitation of consumers. The aim of the present study was to investigate attitudes towards mental illness and people with mental illness among nursing staff working in psychiatric or somatic care. The sample consisted of 120 registered or assistant nurses who were interviewed about intimacy with mental illness and attitudes about seven different mental illnesses. The results showed that nursing staff in somatic care, to a higher degree than nursing staff in mental health, reported more negative attitudes with regard to people with schizophrenia as being more dangerous and unpredictable. In contrast, professional experience, intimacy with mental illness and type of care organization were found to be more associated with attitudes to specific mental illnesses concerning the prospect of improvement with treatment and the prospect of recovery. In conclusion, attitudes among nursing staff are in several respects comparable with public opinions about mental illness and mentally ill persons. In order to elucidate if negative attitudes about dangerousness and unpredictability of persons with specific mental illnesses are associated with realistic experiences or with prejudices further studies with a qualitative design are suggested.     

A decade of stigma and discrimination in mental health: plus ça change, plus c'est la même chose (the more things change, the more they stay the same)

In recent years, efforts to combat stigma and discrimination experienced by mental health service users have ranged from small local initiatives to national and international campaigns. Success has been mixed, with significant, lasting benefits appearing to be elusive. This paper explores the current nature and extent of stigma and discrimination in an area of the north of England and compares findings with those from a study undertaken a decade previously in 1997. Qualitative responses to a postal questionnaire received in 2007 were thematically analysed and compared and contrasted with findings from the 1997 study. Four broad categories of discrimination – (1) employment; (2) professional; (3) communities; and (4) family and friends – arose from the 2007 data, the most common being discrimination in employment. There were close similarities in both sets of data. Stigma and discrimination remain largely as strong, damaging and enduring as they were a decade ago. A range of pre-emptive interventions that support people prior to the escalation of mental health crises could limit the impact of stigma.     

The feasibility,acceptability and sustainability of nurse‐led chronic disease management in Australian general practice: The perspectives of key stakeholders

This was the first Australian study investigating the acceptability, feasibility and sustainability of a nurse‐led model of chronic disease management in general practice. A concurrent mixed‐methods design was used within a 12‐month intervention of nurse‐led care in three general practices. Adult patients with type 2 diabetes, hypertension and/or stable ischaemic heart disease were randomized into nurse‐led or standard care. Semi‐structured interviews explored perceptions of key stakeholders towards this model including patients in the nurse‐led arm, and all practice staff pre‐ and posttrial. The data were thematically analysed and the emergent themes were: importance of time; collaborative relationships; nurse job satisfaction, confidence and competence; patient self‐management and choice. Our findings showed that nurses provided chronic disease management that was acceptable, feasible and sustainable. The collaborative involvement of doctors was intrinsic to patient acceptability of nurse‐led care that facilitated job satisfaction, and therefore retention and growth within this nursing speciality.