Cognitive Function & Early Life Experiences Research Article

Cognitive Function & Early Life Experiences Research Article ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Cognitive Function & Early Life Experiences Research Article 1. Research article must have been written by a nurse 2. Article must be published in a psychiatric nursing journal or in a journal related to psychological topics. Cognitive Function & Early Life Experiences Research Article 3. The article should not be older than 5 years. 4. Your clinical instructor must approve the article. 5. Submit article and only a short summary of the article to clinical instructor. 6. Oral presentation in clinical should include the following information: v Type of research v Purpose of the study v Design/Methods v Sample Size v Type of sample selection v Methodology v Research questions/hypothesis v Analysis tools and tests Results Cognitive Function & Early Life Experiences Research Article outline.docx article_for_nur_383.docx Article outline The article discusses the impact that mental awareness of nurses has on the empathy and care quality, on patience. The way nurses view or perceive mental illnesses can significantly affect the type of treatment a patient receives. Mental illness put patients in a susceptible position to obtain other physical illnesses, if a nurse is more aware of these impacts, it could prevent the prolongation of the treatment for the patient. Published in final edited form as: Arch Psychiatr Nurs. 2016 Dec; 30(6): 788–796. Published online 2016 Jul 12. doi: 10.1016/j.apnu.2016.07.004 PMCID: PMC5127450 NIHMSID: NIHMS805252 PMID: 27888976 The Variability of Nursing Attitudes Toward Mental Illness: An Integrative Review Krystyna de Jacq, NP, Allison Andreno Norful, MSN, RN, ANP-BC, and Elaine Larson, PhD, RN Author information Copyright and License information Disclaimer The publisher’s final edited version of this article is available at Arch Psychiatr Nurs See other articles in PMC that cite the published article. Abstract Mental illnesses are common worldwide and represent the fifth leading disorder globally (Whiteford et al., 2013). About 450 million people suffer from mental illnesses worldwide (World Health Organization, 2001). In the United States (U.S.) alone, over 43.7 million of adults, 18.6% of all the population, have a mental illness diagnosis (National Alliance for the Mentally Ill, 2013). Effective treatments exist, but only 39% of people with diagnosed mental illness receive treatment and among those who receive treatment, one in five terminate treatment prematurely (NIMH, 2001, Olfson et al., 2009). Various factors play a role in decision-making as it pertains to seeking help for mental illness. Those factors include financial concerns, poor self-perception, limited access and stigma (Mojtabai et al., 2011). Goffman (1963) defines social stigma as an attribute that is discredited by society. Hatzenbuehler, Phelan, & Link, 2013, suggested in a recent review that stigma related to mental illness causes health inequalities by preventing people from seeking help that they need. People with depression are more likely to suffer from physical health comorbidities and are reported to be twice as likely as non-depressed patients to have two or more physical illnesses (Smith et al., 2014). According to the Anxiety and Depression Association of America (ADAA), anxiety disorders cost the U.S. more than $42 billion per year, representing almost a third of total mental health spending (ADAA, 2010). Cognitive Function & Early Life Experiences Research Article People who suffer from anxiety disorders are three to five times more likely to visit primary care and gastroenterology than people without the disorder, resulting in increased health care costs (Hoffman, Dukes, & Wittchen, 2008). Delaying treatment for mental illness may result in negative consequences. The longer the duration of untreated illness, the worse the outcomes in psychosis, mood disorders and anxiety disorders (Dell’osso, Glick, Baldwin, & Altamura, 2012). Furthermore, after initiation of treatment, non-adherence and drop out rates may result in unfavorable outcomes (Barrett et al., 2008). A negative patient-provider relationship, or personal and professional characteristics of the providers, may compel the patient to leave treatment (Reneses, Munoz, & Lopez-Ibor, 2009). Hoge et al., (2014) performed a study at a U.S. Veterans Administration Hospital and reported that dissatisfaction with the provider was one of the reasons for patients to drop out of treatment. Furthermore, in a recent integrative review, Newman, D., O’Reilly, P., Lee, S. H., & Kennedy, C. (2015) underlined the importance of relationships between the providers, such as nurses, and the patients who were seeking help for mental health problems. In addition to the patient-provider relationship, the impact of provider stigma is emerging in the literature, and has been identified as the strongest barrier toward help seeking behavior of individuals with mental illness (Clement et al., 2015, Corrigan, 2004; Evans-Lacko, Brohan, Mojtabai, & Thornicroft, 2012; Hinshaw & Stier, 2008; Kim, Britt, Klocko, Riviere, & Adler, 2011). Newman et al., (2015) re-iterated the importance of stigma, affirming that negative nursing attitudes toward mental illness have a profound impact on the delivery of care. Cognitive Function & Early Life Experiences Research Article Similarly, McDonald et al. (2003) confirm that the nurses’ care of patients is negatively impacted if the patient has a mental illness. The investigators presented vignettes that represented three patients admitted to the emergency room with a possible myocardial infarction. 1) The patient was taking an antipsychotic medication; 2) The patient was taking alprazolam (Xanax), a medication used to treat anxiety disorder; and 3) The patient had no history of psychiatric treatment (control). A significant difference in symptom recognition was found. Only 31% of nurses who read the first vignette identified a possibility of myocardial infarction in a patient taking antipsychotic medications compared to 51% of nurses in the control group. Additionally, when patients were experiencing increased anxiety, 78.9% of nurses in the control group stated that they could be having a heart attack versus 45.5% only in the psychotic patient group. This study highlights a general tendency of nurses to stereotype patients with mental illness thereby responding differently to them (McDonald et al., 2003). Corrigan et al., (2014) found that providers’ attitudes were different toward patients with a diagnosis of mental illness than toward those without. Although the factors that influence attitudes regarding mental illness have been studied for many years (Ajzen, 2005; Ajzen & Fishbein, 1980; Fishbein, 2010; Fishbein & Ajzen, 1975; Fishbein, Ajzen, Albarracin, & Hornik, 2007), to our knowledge, there has been no integrative literature review exploring nursing attitudes toward patients with mental illness. Obtaining a clear understanding of nursing attitudes may, inform policy and be used to implement change to ensure optimal patient care. Go to: Aim The aim of this integrative review is to explore nurses’ attitudes toward patients with mental illness. Go to: Methodology Defining Mental Illness The Centers for Disease Control and Prevention (2013) defines mental illness as “disorders generally characterized by dysregulation of mood, thought, and/or behavior, as recognized by the Diagnostic and Statistical Manual, 4th edition, of the American Psychiatric Association.” Cognitive Function & Early Life Experiences Research Article People with mental illness have impaired thinking, and their feelings may affect their ability to function on a daily basis. For the purpose of this review, we used the terms mental illness, mental disorders, and psychological problems interchangeably, which included, but not limited to, mood and psychotic disorders, as well as anxiety. Given the change in mental illness criteria introduced by DSM IV in 1994, only studies that used DSM IV and DSM V were included (American Psychiatric Association, 1994, 2013). Literature Search The conduct of this integrative review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (Liberati, Altman, Tetzlaff, & Mulrow, 2009). We searched the following databases: Ovid MEDLINE, PsycINFO, CINAHL, and PubMed in September, 2015. The following Medical Subject Heading (MeSH) terms were searched: (‘mental illness’ OR ‘mental health’) AND (‘nurses’ OR ‘nurs*’) AND (‘stereotyp*’ OR ‘stigma’ OR ‘prejudice’ OR ‘discrimination’ OR ‘attitudes” OR ‘beliefs’). Data were initially extracted from the four databases by the first author who screened all articles’ titles and abstracts. Two authors independently assessed selected full text articles for eligibility, and the discrepancies were resolved by discussion. The inclusion criteria were studies published between January 1, 1995 and October 31, 2015 in English and included nurses as participants in which the measured outcome was nursing attitudes toward mental health and/or illness in patients. Personal accounts, editorials, and/or single case studies, studies not written in English, and studies that explored attitudes of other professionals were excluded. Quality Appraisal The methodological quality of the studies was assessed using Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies (QATOCCS) from the National Institute of Health, National Heart, Lung, and Blood Institute. The QATOCCS was modified to fit the needs of cross-sectional studies, as many questions were relevant to cohort studies only. Cognitive Function & Early Life Experiences Research Article Two researchers appraised the quality of the studies and 100% consensus of each study’s quality was achieved. Studies were rated in tertiles: low quality (0 – 33%), moderate quality (34 – 66%), and high quality (67 – 100%). Go to: Results The initial database search yielded 2,615 articles, and 2,343 remained after duplicates were removed. Following title screening, 770 papers were identified as potentially eligible and 701 articles were excluded after title and abstract review, leaving 69 articles for full text screening. Fourteen articles met the inclusion criteria. A search of the reference lists of the 14 final articles yielded an additional five articles eligible for inclusion in the study. A full text review by two researchers was performed again and one of the five articles was included in the final review yielding 15 studies that met initial eligibility criteria. Quality Appraisal Two researchers reached consensus on the quality of each study. Twelve studies were determined to be of high quality (Arvaniti et al., 2009; Chambers et al., 2010; Foster et al., 2008; Hamdan-Mansour & Wardam, 2009; Hsiao et al., 2015; Linden & Kavanagh, 2012; Magliano et al., 2004; Munro & Baker, 2007; Nordt, 2006; Scheerder et al., 2011; Serafini et al., 2011; Sevigny et al., 1999). One study score within the moderate quality range (Kukulu & Ergun, 2007). Two studies received lower quality scores because some key methodological elements were not reported, including sampling, sample recruitment and size, and lack of information about study measures. One of these lacked sufficient methodological rigor to be included, leaving 14 studies remaining in the final synthesis of the review. A PRISMA flow diagram is presented in Figure 1. Open in a separate window Figure 1 Flow Diagram The studies were conducted across 20 countries. None of the studies were performed in the U.S. Eight of the studies were conducted in Europe (two of which included more than one country), four in Asia, and three in the Middle East. Of the 14 studies, six focused on attitudes toward schizophrenia and/or depression, while the remaining nine concentrated on mental illness in general. All of the studies had a cross-sectional design.Cognitive Function & Early Life Experiences Research Article Twelve studies included mental health nurses who worked with mentally ill inpatients or outpatients. Aydin, Yigit, Inandi, & Kirpinar, (2003) conducted a study in an outpatient, non-psychiatric setting. Arvaniti et al., (2009) and Scheerder et al., (2010) performed their studies on medical rather than psychiatric units. Study characteristics and key findings are presented in Table 1. Table 1 Study Characteristics Study Arvaniti et Country Greece Sample 130 nurses Measures • The Level of Key Findings (% Nurse Agreement) Contact Report al., 2009 (LCR) 76 physicians • 140 other staff Opinion about students • • • Mentally ill patients should not marry The (53%) Authoritarianism Scale (AS) Mentally ill patients are dangerous (24%) Mental Illness (OMI) 239 medical Social discrimination • 10 medical Mentally ill patients should be separated wards and one from patients without psychiatric ward mental illness of a general (60.7%) hospital Social restriction: • Mentally ill patients should not vote (31%) • Nurses endorsed more restrictive attitudes than physicians • More knowledge about mental illness was associated with Study Country Sample Measures Key Findings more positive attitudes Social integration: • Nurses were more negative than physicians but less authoritarian than medical students Aydin et Turkey 40 nurses • al., 2003 40 academicians 40 physicians 40 hospital • Schizophrenia and • Nurses exhibited depression more negative vignettes attitudes toward a measures: Social person with distance schizophrenia than depression Burden of illness • 100% of respondents said they would be employees disturbed by having a sister marrying a Medical clinics mentally ill person with schizophrenia and depression, but less bothered by working at the same place Chambers Finland et al., 2010 Italy Lithuania 810 nurses • Community Attitudes toward Psychiatric Hospitals (n=21) • Nurses exhibited positive attitudes Study Country Sample Measures Key Findings Portugal the Mentally Ill toward mentally ill Ireland (CAMI) across all countries • Most positive attitude toward mental illness (Portugal) • Most negative attitude toward mental illness (Lithuania) Foster et Fiji 23 nurses al., 2008 • Attitudes Toward Acute Mental 48 orderlies Etiology(% agreement) •Cognitive Function & Early Life Experiences Research Article Health Scale “Mental illnesses are caused by genetic factors” (65.2%) Psychiatric hospital Attitudes “Psychiatric illness deserves as much attention as physical illness” (86.9%) • “Mentally ill have no control over their emotions” (30.5%) • “Manner in which you talk to patients affects their mental state” (91.3%) Study Hamdan- Country Jordan Sample 92 nurses Mansour and Acute and Wardam., chronic mental 2009 health inpatient and outpatient Measures • Attitudes Toward Key Findings • Significant difference Acute Mental in attitudes between Health Scale older and younger nurses • Special training in psychiatric nursing facilities led to more positive attitudes • Higher level of education was associated with more positive attitudes. Nurse Agreement (%) • “Psychiatric Illness deserves as much attention as physical illness” (5.4%) • “Depression occurs in people with weak personality” (68.5%) • “Mentally ill patients have no control over their emotions” (84.8%) • “Mental illnesses are genetic in origin” (76.1%). Study Hsiao et Country Taiwan Sample 180 nurses. Measures • al., 2015 Psychiatric hospitals (n=3) • Jefferson Scale of Key Findings • More negative Empathy-Health attitudes towards Profession version schizophrenia than (JSE-HP) depression (p <.001) Attitudes of • The older the nurse, Mental Illness the more positive Questionnaire attitude (p <.01) (AMIQ) • The more experience the more positive attitudes (p <.001) • There was a positive correlation between empathy and attitudes toward mental illness (p <.01) • There were no gender difference (p =.84) • Staff nurses endorsed more negative attitudes than nurse managers (p <.02) • Nurses on acute psychiatric units endorsed more negative attitudes toward schizophrenia than nurses who worked in community-based Study Country Sample Measures Key Findings outpatient clinics (p =.006) Kukulu Turkey 543 nurses and Ergun, 2007 • Questionnaire reported in Psychiatric Etiology(% Agreement) • Turkish language Schizophrenia present from birth (93.2%) wards of teaching Cognitive Function & Early Life Experiences Research Article • Schizophrenia caused by social problems hospitals (51.4%) Social distance • “People with schizophrenia should be free in society” (31.9%) • Could work with people with schizophrenia (56.7%) • Could marry a person with schizophrenia (8.3%) • Have a neighbor with schizophrenia (42.9%) • Rent home to a person with Study Country Sample Measures Key Findings schizophrenia (63.2%) Linden Ireland 121 nurses • and Community CAMI • Attitudes toward Kavanagh 66 student 2012 mental health Mental Illness social restrictiveness Scale (CAMI) and authoritative nurses • Inpatient and Nurses disagreed with attitudes toward Social Interaction mental illness Scale (SIS) • Community Nurses agreed with integrating mentally Setting (n=2) ill into the community • Nurses agreed with exhibiting benevolent attitudes toward those with mental illness • Community mental health nurses showed more positive attitudes than those who worked in inpatient setting SIS • Inpatient mental health nurses showed more socially restrictive attitudes Study Country Sample Measures Key Findings than nurses in a community setting. Magliano Italy 190 nurses et al., 2004 • Opinions About Mental Illness 110 psychiatrists Questionnaire Etiology of schizophrenia (% Nurse agreement) Heredity (74%); Stress (53%); Alcohol (42%), Drugs (48%); 709 patient Family conflict (48%), Trauma relatives (36%) Mental health Social functioning services (n=30) • “Patients with mental illness should work as other people” (79%) • “Patients with schizophrenia are unpredictable (86%) Civil rights • Patients with schizophrenia should be responsible in court (72%) • Patients with schizophrenia should vote (66%) • Patients with schizophrenia should not get married (63%) Study Country Sample Measures Key Findings • Patients with schizophrenia should not have children (72%) • Wife of patient with schizophrenia should be allowed to divorce upon diagnosis (50%) Munro and England 141 nurses Baker 2007 • Attitude Toward Acute Mental Acute mental Health Scale Positive Attitudes (% Nurse Agreement) • health unit “Psychiatric illness deserves at least as much attention as physical illness” (80%) • “Depression occurs in people with a weak personality” (20%) Negative Attitudes • Psychiatric drugs are used to control disruptive behavior” (67%) Neutral Attitudes Study Country Sample Measures Key Findings • “Mental illness is genetic in origin” (46.4%) • “Cognitive Function & Early Life Experiences Research Article People are born vulnerable to mental illness” (45.7%) Nordt et Switzerland 684 nurses • al., 2006 204 psychiatrists Computer • Nurses and Assisted Psychiatrists reported Telephone similar negative Interview attitudes 185 other professionals • Social Acceptance • Nurses endorsed Psychiatric higher social distance wards of toward people with hospitals (n=29) schizophrenia than toward people with depression. Outpatient clinics (n=3) 1737 members of the general Social restrictiveness (% Nurse Agreement) public • Mentally ill people should have driver’s license revoked (46%) • In favor of withdrawing the right to vote (2.8%) Study Country Sample Measures Key Findings • Mentally ill should abort when pregnant (9.8%) • In favor of compulsory admission (98.2%) Scheerder European et al., 2011 Alliance Against Depression 887 nurses Adaptation of 3 tools • 334 nursing assistants Belgium 169 mental Estonia health France professionals Germany (physicians and Hungary mental health Ireland professionals) • • Mental health Depression professionals had the Attitude least negative Questionnaire attitudes toward people with Defeat Depression depression and the Questionnaire use of • Instruments of EAAD partner countries antidepressants. • Nurses had more negative attitudes toward people with Italy Scotland 968 community Slovenia facilitators (clergy, social workers) from a depression Positive Attitudes toward mental health (% agreement) training program and professional • “Depression is a real disease” (60% nurses; associations 95% physicians) • “Depression can be treated” (81.9% nurses; 95.8% physicians) Study Country Sample Measures Key Findings Negative attitudes toward treatment (% agreement) • An … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10