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ORIGINAL ARTICLE Table of Contents  
Ahead of print publication
Study on perception towards psychiatry among nursing students in a tertiary care hospital


1 Assistant Professor, Department of Psychiatry, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India
2 Associate Professor, Department of Psychiatry, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India
3 Professor, Department of Psychiatry, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

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Date of Submission30-Jul-2021
Date of Acceptance24-Sep-2021
Date of Web Publication23-Nov-2021
 

  Abstract 


Introduction: Nursing fraternity plays a pivotal role in psychiatric services. Psychiatric conditions and persons suffering from them may elicit the different kinds of attitudinal responses. While there are multiple factors leading to an individual's decision to specialize in psychiatry, the individual's perceptions and attitudes toward psychiatry tend to play an essential role
Aim: The current study aimed at assessing the attitude toward psychiatry among nursing students at a tertiary care hospital.
Design: Cross-sectional study.
Materials and Methods: One hundred and thirty-seven nursing students from Tertiary care teaching hospital were recruited the study and administered attitudes assessed using Attitudes toward Psychiatry-18 Scale.
Statistical Analysis: Data were analyzed using the SPSS statistics version 23.
Results: Majority of respondents showed favorable attitudes toward 14 items and unfavorable attitudes in remaining 4 items. Only 29.9% participants expressed their willingness to specialize in psychiatric nursing.
Conclusions: A study found majority of students having favorable attitudes toward psychiatry. More can be done in the present education and training curriculum to develop empathetic attitudes toward people with mental illness, as it will affect the way these prospective nursing students deliver care toward their patients.

Keywords: Attitude, nursing students, psychiatry


How to cite this URL:
Sailahari KV, Abhinaya R V, Ramireddy K V. Study on perception towards psychiatry among nursing students in a tertiary care hospital. Arch Ment Health [Epub ahead of print] [cited 2021 Dec 7]. Available from: https://www.amhonline.org/preprintarticle.asp?id=330921





  Introduction Top


While there are multiple factors leading to an individual's decision to specialize in psychiatry, the individual's perceptions and Attitudes Towards Psychiatry (ATP) tend to play an essential role.[1] Nurses play a vital role in caring for the mentally ill in sickness and in rehabilitating the mentally ill after an acute episode of illness. Limited treatment success specifically in treating patients who do not fully recover or relapse frequently also tends to contribute to a more pessimistic view of psychiatry.[2] The attitudes and knowledge of the health care professionals on mental illness has been argued to be a major determinant of the quality and outcome of care for mentally ill patients.[3] Notably, healthcare professionals who are taking care of psychiatric patients also experience “stigma by association” in which they are subjected to similar stigmatizing stereotypes. People suffering from mental illness commonly face stigma, bias, and discrimination by general public. Health care professionals are not immune to social biases and share the public's attitude met out to people with mental illness. Nursing students are future health manpower. There are misperceptions and a lack of understanding about patients in the psychiatric setting which contributes to negative opinions and attitudes held towards them.[4] This study thus aimed to explore understanding of mental illness, increased readiness to seek mental health care and more tolerant ATP among nursing students. This study expands the literature in this area by exploring ATP amongst nursing students in Tertiary care hospital.


  Materials and Methods Top


It was a cross-sectional study conducted after getting ethical clearance from the institutional ethics committee. Participants included nursing students studying in 1st–3rd year of their course in a tertiary care hospital on purposive sampling. The participants were informed about the study objectives and after their informed consent, were requested to fill the forms. The study forms included basic sociodemographic details, year of study, ATP, likelihood of specializing in Psychiatric nursing and ATP-18.

Attitudes Towards Psychiatry-18

This is a 18-item self-report instrument that was originally developed by Wilkinson to measure specific ATP, including both academic and clinical domains of psychiatry as well as attitudes towards psychiatrists and patients in the psychiatric settings. Of the 18 items, 9 (items: 2, 5–7, 11, 13–15 and 17) express positive views while the other 9 (items: 1, 3, 4, 8, 9, 10, 12, 16 and 18) express negative views. In this study, we adopted a 5-point Likert scale measure for each item (1 = strongly agree; 2 = agree; 3 = neutral; 4 = disagree; 5 = strongly disagree). Positive items were reverse coded and scores were summed, whereby the lowest possible score is 18 and the highest possible score is 90. Higher scores indicate more favourable ATP.[5]

Statistical analysis

A total of 137 participants filled the forms. The data thus obtained was populated into Microsoft Excel sheet and analysed using IBM SPSS Statistics Version 23 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were performed to get frequencies, means and percentages. Inferential statistics was performed using Pearson Chi-square test and a P value of 0.05 was considered as significant. Mathematical operator df=2.


  Results Top


Sociodemographic details

The study consisted of 44 participants (32.1%) from 1st year, 71 (51.8%) participants from 2nd year and 22 (16.05%) students from 3rd year. All the participants belong to age group of 18–22 years. Participants belonged to various geographical areas, 101 (73.7%) from Andhra Pradesh, 28 (20.4%) from West Bengal, 6 (4.3%) from Kerala and 2 (1.4%) from Jammu and Kashmir. 79 participants (57.6%) were residing in college hostel and 58 participants (42.3%) were day scholars. Summarized in [Table 1].
Table 1: Sociodemographic data

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Attitudes Towards Psychiatry-18

The participants had a mean score of 67.34 ± 7.2. A score of sixty or more indicates positive attitudes towards, hence the study participants had overall positive attitudes. Among the items, favourable attitudes were towards 14 items (1, 3–8, 11–17) and unfavourable attitudes towards the remaining 4 items; which were 2, 9, 10 and 18. More than 90% of participants have agreed to the following statements “Psychiatrists try to treat the whole patient and not just the disease,” “Psychiatric skills are essential in general practice,” “Mental illness presents us with one of the great challenges within the field of medicine” and “Empathy with patients is as important as factual knowledge in clinical practice.” Summarized in [Table 2] and its subsets. Regarding specialisation in psychiatric nursing, 29.9% participants showed interest. But the finding was not significant among the participants of various years of education. Summarized in [Table 3].
Table 2: Item response on Attitudes Toward Psychiatry-18 questionnaire

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Table 3: Choosing psychiatry nursing as a career

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  Discussion Top


As prospective health care providers who are at the front line of contact with people in the community, both medical and nursing students have a pivotal role in identifying mental health issues and delivering quality care in future. Health care providers may come across people with mental health conditions in various settings. Having negative ATP among nursing students may affect the way they cater the needs of mentally ill patients in future. This could lead to undesirable consequences in patient care, such as the failure of appropriate referral if patients' needs are misunderstood, for instance in suspecting that physical complaints are imagined.[6]

In day to day practice it is seen that undergraduate nursing students show unfavourable attitudes toward psychiatric/mental health nursing as a career.[7] Nursing students are future health manpower of our country. They will be part of societal development. Prior studies have also shown that those who sought treatment have reported stigmatizing attitudes from various healthcare providers.[8] Fisher found that nursing students were at risk of developing negative attitudes in clinical placements that exposed them to situations in which they were ill-prepared for.[9],[10],[11]

In the current study nursing students had positive attitudes which are consistent with prior studies conducted in other nursing populations across various countries. This is in support with Study conducted by Rüsch et al.[12] Studies have also explored aspects of psychiatry education that could help to improve the image of psychiatry. Rüsch et al. found that education, and contact with psychiatric patients, are associated with better attitudes towards them. Specifically, the majority of students in this population endorsed favourable attitudes towards the following aspects of psychiatry [[Table 2] and subsets]: Challenges within psychiatry (item: 7, 11), the importance of psychiatry and psychiatric skills (item: 14, 15, 17), beliefs about treatment outcomes (item: 8) and view towards psychiatrists (item: 1, 3, 5, 13). In fact, prior studies showed that nursing students endorsed less stigmatizing attitudes after being educated. Hence, good quality of clinical teaching, supervision, organization of clinical placement, patient contact and seeing patients respond positively to treatments during placements are the factors that create a positive attitude. In a study conducted among 1st year nursing students, psychiatric nursing as a prospectus career was not considered due to negative attitudes towards mental illnesses. Therefore, it is important to emphasize positive attitudes towards psychiatric nursing during the nursing education.[12]

In this study the majority of participants showing positive interest towards psychiatric nursing could be due to exposure to psychiatry department and rigorous clinical postings. It was also found that encouragement received from senior psychiatrists during clinical placements is correlated to better ATP and increased interest in pursuing psychiatry as a career.[13]

Majority of the participants also felt that the time allotted to them in psychiatry in their curriculum was too little. A study by Holm-Petersen et al.,[14] also found contact experience with psychiatrists and the work psychiatrists perform to be associated with better attitudes after clinical placements, specifically in attitudes towards clinical content, effectiveness of treatment and perceived difficulty in working with patients. While psychiatric placements present an opportunity to influence students positively, it is also a crucial to foster these positive attitudes towards people with mental illness in their preclinical years and in various other curricula aside from psychiatry, especially since attitudes tend to be more amendable to change early on in training and harden as they progress through their program.[15]

Attitudinal interventions and de-stigmatisation strategies should be specifically focused towards selected training experiences such as in helping to prepare students for the realities of clinical placements to maximize the experience. It is important to note that while ATP are generally positive, the most negative attitudes are found to be towards psychiatric patients. Perhaps educators could work towards fostering greater empathy and understanding of mental health issues in their curriculum to improve attitudes towards psychiatric patients. Importantly, understanding how students learn and make sense of their clinical experience would also be helpful in applying appropriate pedagogic theory to help students overcome negative views developed during placements. Psychiatric nursing curricula must include topics and programs that will create awareness in students regarding stigmatization towards mental illnesses and its effects. It is recommended to conduct longitudinal studies investigating students' beliefs towards mental illnesses, perceptions of Psychiatric nursing training, and career choices from the very 1st year of their nursing education. Additionally previous studies have commonly reported the potential of clinical placements in improving attitudes towards people with mental illness thereby emphasising the importance of enriching students' experience in this regard. Hence, educators could attempt to increase students' self-esteem and sense of competence to undergo their clinical placements before it begins by ensuring their preparedness, managing their expectations and equipping them with relevant communication skills, especially in dealing with nonadherent patients. Educators could attempt to have an open discussion with students to identify specific components of theoretical (lectures) and clinical education (clinical placements) that are viewed more positively or negatively in order to aid the development of positive attitudes towards people with mental illness and also encourage a career in psychiatry.


  Conclusions Top


This study found that the majority of nursing students endorsed favourable ATP. We felt that there is still room for improvement in the present education and training curriculum to develop empathetic attitudes towards people with mental illness, as it will affect the way these prospective health care professionals deliver care towards their patients.

Limitations

The present study has limitations which include a small sample size. The study was limited to one center and hence does not reflect the attitudes from other geographical areas.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Holm-Petersen C, Vinge S, Hansen J, Gyrd-Hansen D. The impact of contact with psychiatry on senior medical students' attitudes toward psychiatry. Acta Psychiatr Scand 2007;116:308-11.  Back to cited text no. 14
    
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Nieuwhof MG, Rademakers JJ, Kuyvenhoven MM, Soethout MB, ten Cate TJ. Students' conceptions of the medical profession; an interview study. Med Teach 2005;27:709-14.  Back to cited text no. 15
    

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Correspondence Address:
Kakarla V. M. Sailahari,
D/o K. S. Prasada Rao, LIG-A-130, Sagar Nagar, Visakhapatnam - 530 045, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/amh.amh_114_21




 
 
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  [Table 1], [Table 2], [Table 3]



 

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    -  Sailahari KV
    -  Abhinaya R V
    -  Ramireddy K V


   Abstract
  Introduction
   Materials and Me...
  Results
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