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PERCEPTION AND ATTITUDE OF BACCALAUREATE NURSING STUDENTS TOWARDS PSYCHIATRIC AND MENTAL HEALTH NURSING AS A CAREER

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CHAPTER ONE

INTRODUCTION

Background to the Study

Psychiatric and mental health nursing is a specialized area of nursing practice committed to promoting mental health through the assessment, diagnosis, and treatment of human responses to mental health problems and psychiatric disorders (ANA, 2007). Psychiatric and mental health nursing can equally be described as a core profession, which employs a purposeful use of self as its art and a wide range of nursing, psychosocial, and neurobiological theories and research evidence as its science in the promotion and management of mental health and mental illness (ANA, 2007). Furthermore, psychiatric and mental health nurses provide comprehensive, patient-centred mental health and psychiatric care and outcome evaluation in a variety of settings across the entire continuum of care. Essential components of this specialty practice include health and wellness promotion through identification of mental health issues, prevention of mental health problems as well as care and treatment of persons with psychiatric disorders (Psychiatric Mental Health Nursing Scope & Standards, 2006).

In spite of the above recognition of vital and fulcrum roles played by psychiatric nurses in issues of mental health, globally there are published empirical evidence of dearth of mental health nurses. Examining this assertion in Nigeria situation through a study carried out by Izibeloko and Leana (2013), Nigeria has  a  ratio  of mental health bed of 0.4 per 100.000 persons, 4 psychiatric nurses per 100 000 persons, 0.09 psychiatrists and 0.02 psychologists and social  workers  per  100  000  persons  and  a  total  public  health expenditure  of  5%  of  the  country’s  budget  for her mental health . Unarguably, this statistical number of mental health nurses is no match to carter for the mental health of over 160 million Nigerians. This could reflect how health professionals are not venturing into psychiatric and mental health as a way of specialization.

Among the factors that may contribute to reluctance on the part of new graduate nurses to enter psychiatric mental health nursing, is a lack of understanding about the contributing factors to mental illness, and stigma can be a principal barrier to promoting psychiatric mental health nursing (Stuhlmiller, 2005). Society holds outdated beliefs about mental illness (Halter, 2008). A central theme of stigma of mental illness is a perception that persons with mental illness are dangerous, unpredictable, incompetent and unlikeable (Alexander & Link, 2003). Persons with mental illness experience stigma and the healthcare professionals taking care of them also experience ‘stigma by association’ (Halter, 2008). As long as this stigma exists, the possibility of consumers of mental health services receiving optimal care is severely diminished (Happell, 2005), as is the vision of psychiatric mental health nursing as a satisfying, worthwhile area of practice.

It may be possible that nurses will hold the same stigmatizing attitudes as have been found in the general population if nursing education does not address stigma, which includes; beliefs that persons with mental illness are not only in control of their illness but that they caused it (Ilic et al., 2013). Similarly, nurses, as society in general, may react to persons with mental illness with anger and belief that help is not deserved (Romem, Anson, Maymon, & Moisa, 2008). None of these beliefs encourage nurses to enter practice settings with persons with mental illness. According to Happell and Gough (2007), although most undergraduate, pre-licensure nursing students report being relatively well informed about mental illness, they also have negative stereotypes towards mental illness and consumers of mental health services. This perception also brings about the idea that mental health nursing is stressful (Karimollahi, 2011). Student nurses report intense anxiety stemming from fear of the unknown, media effects, peer effects, fear of violence, and erroneous beliefs (Karimollahi, 2011).  This anxiety is caused by students’ perceived lack of preparation for work in mental health settings compared with medical-surgical settings, but interactions with persons with mental illness can reduce students’ fears and apprehension (Happell & Gough, 2009). Undergraduate students also receive negative information from their peers regarding acute psychiatric care units, further perpetuating existing fears (Karimollahi, 2011). A negative clinical experience can have a detrimental effect on a student’s view of mental health nursing, making it unlikely that they will choose psychiatric/ mental health nursing as a career.

Globally, a persistent negative attitude and social rejection of people with mental illness has prevailed throughout history in every social and religious culture (Luty, 2010).  These negative feelings are not only limited against the mentally ill but also towards career in psychiatric/mental health nursing. Adverse attitudes by nursing students, usually in the form of discrimination, separatism, social distancing, and misconceptions are a crucial issue not only for the mentally ill  and their families, but also for research, advocacy and policy across the world (Kapungwe, 2011).

The World Health Organization (WHO) in 2008 also identified a global shortage of nurse psychiatrists, whereas the need for nurse psychiatrists is growing fast (Cour des comptes, 2011). Attitude of nursing student’s is directly related to the quality and outcome of care given to the mentally ill as well as choice of career in psychiatry/mental health nursing. Attracting nursing students to specialize in psychiatry is a major issue of concern. It is therefore on this premise that the researcher is spurred to determine the attitude towards a career in psychiatric nursing among undergraduate students of Department of Nursing UNEC.

Statement of Problem

It is no hidden truth that the number of Nigerians seen wandering the streets due to mental problem explains the mental health situation in Nigeria. Similarly, the rate at which our national dailies are abashed with cases of rape of minors, incest, accusations and counter-accusations of witchcraft and bewitchment, domestic violence, wife battering, divorce, human ritual sacrifices are pointers to poor mental health status of Nigerians as these are aliens to  a sane society.

As documented by Izibeloko and Leana (2013), Nigeria of over 160 million people  has eight schools of psychiatric Nursing, and twelve medical schools, with all mental health services  being provided only  at these institutions at  a ratio of 4 psychiatric nurses per 100 000 persons. The unsavoury effects of not using trained psychiatric nurses to render nursing care services to psychiatric patients are frequent reports of  nursing staff being victims of patients’ aggression, unskilled and unprofessional services leading to  attack of nursing staff by aggressive patients,  low staff turnover, elongated hospital admission to mention but a few (Ballard, 2010). Considering staff shortage or unskilled individuals, one wonders if the nurses in training have interest to undertake specialization in nursing this stigmatized group of patients.

Therefore, this study investigates the perception and attitudes of nursing students of University of Nigeria, Enugu Campus (UNEC) towards psychiatric and mental health nursing as a career.

Purpose of the Study

The purpose of this study is to investigate the perception and attitude of nursing students of UNEC towards mental health nursing as a career.

Objectives of the Study

The Specific Objectives of this Study were to:

  • Determine the perception of nursing students towards mental health nursing as a career.
  • Determine the attitude of nursing students towards mental health nursing as a career.
  • Identify the factors influencing the students’ perception and attitude towards mental health nursing as a career
  • Compare the perception of nursing students of 400 level and 500 level towards choosing mental health nursing as a career.
  • Compare the attitude of nursing students of 400level and 500level towards choosing mental health nursing as a career.

Research Questions

In an attempt to establish a firm grip of this study, the following research questions are posed:

  1. What is the perception of nursing students towards mental health nursing as a career?
  2. What is the attitude of nursing students towards mental health nursing as a career?
  3. What are the factors influencing the students’ perception and attitude towards mental health nursing as a career?
  4. What are the differences in perception of students of nursing of 400level and 500level towards mental health nursing as a career?
  5. What is the difference in the attitude of students of nursing of 400level and 500levl towards mental health nursing as a career?

 

 

 

Hypotheses

  1. There will be no significant difference in factors that influence nursing students’ perception and attitude towards mental health nursing as a career amongst students of 400level and 500level.
  2. There will be no significant difference in number of students willing to choose mental health nursing as a career between nursing students of 400level and 500level.

Significance of the Study

The results of the study will help to identify subsisting perception and attitude of nursing students towards mental health nursing as area of specialty in nursing practice with a view to inculcating positive perception and attitude in undergraduate/basic nursing students towards career in mental health nursing. This has propensity to increase number of undergraduate/basic nursing students intending to major in mental health nursing in their postgraduate/post basic academic programmes and consequently put to an end the current practice of using untrained psychiatric nurses to render nursing services to patients in psychiatric hospitals.

Similarly, findings from the study will expose various factors influencing perception and attitude of nursing students towards mental health nursing as a career of choice in their nursing practice. These findings will be vital to stakeholders in nursing education and practice as it will help to direct policy formulation and curriculum framing.

Also, submissions from the study will help stimulate government’s interests with a view to making mental health nursing very attractive through formulation of right policies  and giving  incentives to students training in mental health nursing as well as practising mental health nurses to boost their morale and ultimately  bring succour to psychiatric patients and their families who  have been receiving unskilled and unprofessional psychiatric nursing services on account of using non-psychiatric-trained nurses in psychiatric hospitals/rehabilitation-centres  due to dearth of psychiatric trained nurses.

Scope of the Study

The study is delimited to perception and attitude of nursing students of UNEC towards mental health nursing as a career and also the factors influencing perception and attitude of nursing students of UNEC towards mental health nursing as a career.

Operational Definition of Terms

The following terms are defined operationally as applied to this study

Nursing as a Career: Nursing students most preferred area of specialization in nursing practice

Attitude towards mental health nursing as a career: A measure of the cognitive, affective and behaviour of nursing students towards mental health nursing as a career on account of what they think and feel about mental health nursing. For the sake of this study attitude will be regarded as willingness to specialise and practice psychiatric and mental health nursing

Perception of mental health nursing as a career: A measure of how nursing students regard, understand and interpret mental health nursing as preferred area of specialization.

University of Nigeria Enugu campus Nursing Students: 400-500 level baccalaureate nursing students of University of Nigeria Enugu campus who have been exposed to clinical postings in mental health nursing.

Psychiatric mental health nursing: is an area of nursing specialty that cares for people of all ages with mental disorders or predisposed to mental illness, that is choosing as a career by nursing students after obtaining their basic nursing training certificate or pursue as a postgraduate degree.

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