APNA 29th Annual Conference Session 4014: October 31, 2015 Disclaimer Nursing Student Attitudes toward Mental Illness: This presenter has no conflicts of interest, A Quantitative Quasi-Experimental Study commercial support, or off-label use to disclose. Todd Hastings, PhD, RN Bloomsburg University The Problem and Purpose The Literature Problem: Nursing students have negative attitudes about the Nursing students have negative attitudes about the mentally ill and psychiatric treatment mentally ill and psychiatric treatment, influenced by a range of contributing factors: Society – stereotypes passed on, poor media portrayals Purpose: To examine and clarify nursing student Staff nurses and psychiatrists – pass on their own stigma perceptions of mental illness relative to attitudes, sense of Nursing faculty – even instructors pass on their own prejudice knowledge, preparedness, and potential career choice Nursing students do not feel insightful about mental illness or ready to work with mental health patients Evidence supports how adverse clinical experiences, poor treatment for psychiatric patients, and less interest in psychiatric nursing as a career may all follow negative attitudes held by nursing students about mental illness. 4 4 The Literature Theoretical Framework Labeling Theory Benner Model However more classroom content and clinical exposure promote improved nursing student attitudes relative to Peplau’s Theory on Interpersonal Relations mental health treatment cultures Other strategies including targeted classroom interventions using media or problem-based learning, role play, simulation, and reflection show promise for improving nursing student attitudes 4 5 Hastings 1
APNA 29th Annual Conference Session 4014: October 31, 2015 Research Questions Research Method and Design Is there a difference in attitudes towards mental illness and mental health patients amongst nursing students after enrollment in a Quasi-experimental quantitative study psychiatric nursing course? Is there a difference in how knowledgeable nursing students feel regarding mental illness and mental health treatment after enrollment pre-test/post-test format: NR-O-X-O design in a psychiatric nursing course? NR=non-randomized Is there a difference in the perception of preparedness to work in the O=assessment/survey (dependent variables) psychiatric mental health specialty amongst nursing students after X=intervention or independent variable (PMH class) enrollment in a psychiatric nursing course? Is there a difference in undergraduate student’s interest for pursuing the psychiatric mental health specialty as a career area in nursing after a psychiatric nursing course? 6 7 Data Collection Method Population and Sample Only those agreeing to participate – voluntary Eight Bachelor of Science in Nursing programs – students in their mental health Informed consent obtained nursing course (junior or senior year) Surveys = First and Last Day of Placement – 24 questions about student perceptions of mental Total nursing students completing pre- and illness and treatment of mentally ill post-test surveys – 310 (power =>253) Administered prior to starting clinical and at end of PMH course Matched for participant 8 9 Demographic Data Results: Item Means for First and Last Day of Placement Surveys for Items Associated with Factors Studied: Factor Sample Characteristics Frequency (N=310) Valid Percent for Attitudes Toward Mental Illness – Negative Stereotypes Gender: (Items 8, 21, 24) Male 40 12.9 Female 270 87.1 Item from First Day and Last Day of Placement Surveys First Day (pretest) Last Day (posttest) Year of Placement Second Year (Junior Level) M SD M SD 160 51.6 Third Year (Senior Level) 150 48.4 Item 8: People with mental illness 4.36 1.33 3.66 1.35 are unpredictable. Institutional Placement – Professional (BSN) Programs Traditional Programs College A (mid-sized public university) 34 11.0 Item 21: People with mental illness can’t 3.19 1.32 3.04 1.23 College B (small private university) 46 14.8 handle too much responsibility. College C (small private university – 2 sections) 67 21.6 College D (mid-sized public university – 2 sections) 55 17.7 College E (large public university) 39 12.6 Item 24: People with mental illness are 3.83 1.43 3.79 1.49 Non-Traditional Programs more likely to commit offences or crimes. College B - Part Time Evening Program 24 7.7 College F – branch campus of 14 4.5 large public university College G – branch campus of 31 10.0 large public university 11 Hastings 2
APNA 29th Annual Conference Session 4014: October 31, 2015 Results: Item Means for First and Last Day of Placement Results: Item Means for First and Last Day of Placement Surveys for Items Associated with Factors Studied: Factors Surveys for Items Associated with Factors Studied: Factors for Preparedness for Mental Health Field (Items 1, 4, 7, 10 ) for Knowledge About Mental Illness (Items 9, 18, 19, 23) Item from First Day and Last Day of First Day (pretest) Last Day (posttest) Item from First Day and Last Day of First Day (pretest) Last Day (posttest) Placement Surveys M SD M SD Placement Surveys M SD M SD Item 9: Mental illness is not a sign 5.76* 1.44 6.01* 1.46 Item 1: I feel well prepared for my 3.63 1.32 4.71 1.33 of weakness in a person psychiatric/mental health clinical placement Item 18: Someone I know has 5.84* 1.72 6.00* 1.50 experienced a mental health Item 4: I have a good 3.52 1.32 5.46 1.20 problem. understanding of the role of a psychiatric nurse Item 19: When a person develops a 5.88 1.18 5.96* 1.23 mental illness it is not their fault. Item 7: I feel confident in my ability 3.62 1.37 5.15 1.07 to care for people experiencing a Item 23: The way people with 6.00 1.00 6.13 .9327 mental health problem. mental illness feel can be affected by other people’s attitudes towards Item 10: My theoretical component 3.61 1.27 5.09 1.27 them. of PMH nursing has prepared me well for my clinical placement. 12 13 Results: Item Means for First and Last Day of Placement Surveys for Items Associated with Factors Studied: Factors Results: Instrument Reliabilities (Cronbach’s alpha values) for Future Career Interest in Mental Health (Items 6 and 12) for Factor Subscales Factor Subscale First Day Last Day Original of of Reliabilities by Placement Placement Tool Authors* Item from First Day and Last Day of First Day (pretest) Last Day (posttest) Tool Tool Placement Surveys M SD M SD Item 6: I will apply for a Graduate 2.11* 1.29 2.24 1.38 Program in psychiatric/mental health Negative Stereotypes/Attitudes (NSs) .56 .60 .51 nursing. (items 8, 21, 24) Knowledge of Mental Illness (KMI) .51 .57 .56 Item 12: I intend to pursue a career in 2.61 1.48 2.69 1.74 (items 9, 18, 19 23) psychiatric/mental health nursing. Preparedness to Work in Mental Health (PMHF) .79 .75 .72 (items 1, 4, 7, 10) Future Career Interest in MH (FC) .84 .88 .92 (items 6, 12 ) 14 15 Results: Dependent Sample means and standard deviations Results: Paired differences (pre-test minus post-test) and Dependent with correlations for First Day of Placement (pre-test) and Sample t -tests for First Day of Placement (pre-test) and Last Day of Last Day of Placement (post-test) Score for Subscales related Placement (post-test) Scores for Subscales related to Nursing Student to Nursing Student Responses to Surveys (N=310) Responses to Surveys (N=310, df=309 ) Subscales (factor variables) Mean (SD) Pre- Mean (SD) Difference Correlation Subscales (factor Difference of Means Confidence Intervals Sig.(2-tailed) Test Post-Test Post-Test minus for variables) Post-Test - Pre-Test Lower Upper t statistic α =.05 Pre-Test Paired Samples Negative Stereotypes (Attitudes) 11.39 (2.99) 10.49 (3.04) -.90 .46 of the Mentally Ill (NSs) Negative Stereotypes -.90 -.55 -1.25 -5.03 .000* (Attitudes) of the Mentally Ill Knowledge about Mental Illness 23.49 (3.48) 24.10 (3.43) .61 .58 (KMI) Knowledge about Mental .61 .96 .25 3.36 .001* Illness Perception of Preparedness to 14.37 (4.12) 20.40 (3.67) 6.03 .09 Work in Mental Health Field Preparedness to Work in 6.03 6.62 5.44 20.16 .000* (PMHF) Mental Health Settings Future Career Interest in .215 .505 -.075 1.46 .146 Future Career Interest in Mental 4.72 (2.57) 4.93 (3.43) .22 .57 Mental Health Specialty Health Specialty (FC) 16 17 Hastings 3
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