A Survey of the Attitudes of Nurses towards Caring for the Mentally Ill at a Rural General Hospital

Special Article - Psychiatric Nursing

Austin J Nurs Health Care. 2016; 3(2): 1034.

A Survey of the Attitudes of Nurses towards Caring for the Mentally Ill at a Rural General Hospital

Matthews LM¹, Rhoden-Salmon DD²*, Silvera H², Waite MJ² and Barton-Gooden AO²

¹St. Thomas Health Department, Jamaica

²UWI School of Nursing University of the West Indies, Jamaica

*Corresponding author: Rhoden-Salmon DD, UWI School of Nursing University of the West Indies, 9 Gibraltar Camp Way, Mona, Kingston 7, Jamaica

Received: November 16, 2016; Accepted: December 12, 2016; Published: December 14, 2016


Background: Mental illness is a global problem affecting millions of people. There has been an increase in the number of mentally ill persons who are treated in the general hospital setting due to decentralization of mental health services.

Objectives: The purpose of the study is to explore the attitudes of nurses at a rural general hospital, with an aim to improve services offered to persons with mental illness.

Methods: A descriptive study survey was carried out among nurses in a general hospital. The data was collected through a self-administered questionnaire which was taken from a previous study. Data was analyzed using SPSS® version 20.

Results: A total of 84 questionnaires were administered with a response rate of 92.8%. All respondents were females with an average age of 35.7±8.3 years. Most of the nurses (42%) had 11-41 years of work experience. Most of the nurses (70.5%) had a negative attitude towards caring for the mentally ill. All nurses had psychiatric nursing in their basic training but only 98.7% had no additional training and 88% had no continuing education in psychiatric nursing. The majority (88%) of the nurses had a positive attitude towards the environment in which care is offered to the mentally ill.

Conclusion: Most of the nurses surveyed had a negative attitude towards mental illness. There needs to be more trained psychiatric nurses in the hospital and continuing education sessions/workshops to reduce the negative attitudes of these nurses. More research is needed to have an in-depth understanding of the issues.

Keywords: Nurses; Attitude; Mentally ill; General hospital


WHO: World Health Organization; UHWI/UWI/FMS: University Hospital of the West Indies/University of the West Indies/ Faculty of Medical Sciences


Mental illness is a global problem affecting over 179 million persons [1]. The effects on disability, co-morbidity and mortality are felt universally [2]. In 2000, the Ministry of Health in Jamaica introduced the concept of decentralization and deinstitutionalization of mental health services from the mental hospital [3]. As a result, each parish is required to treat all their mentally ill in the general hospital setting instead of sending them to a psychiatric hospital. The implications for this are that patients would be cared for in general hospitals throughout the country and will be exposed to nursing personnel who have minimal experience or exposure dealing with the mentally ill.

Hogberg, Magnusson and Lutzen conducted a study of psychiatric nurses which reveals that additional knowledge about mental illness doesn’t always bring about positive attitudes towards persons with mental illnesses [4]. Mental health nurses were also found to have negative views and discriminatory behaviors towards clients suffering with a mental illness [5]. A descriptive correlational design of 92 mental health nurses found that 60% of the psychiatric nurses in Jordan have negative attitudes toward these patients with mental illness, and the quality care provided to those patients were of low standards [6].

A cross sectional study done across five European countries, found that nurses working in mental health in general have a more positive attitude towards persons with mental illness based on their country’ practice, gender and position. In Portugal, the nurses have a more positive attitude compared with Lithuania. These differences could be as a result of the organization of the psychiatric services in Portugal [7]. This study can be generalized as the study was done across five countries and a sample size of 810 nurses.

The aim of this study is to investigate the attitude of nurses working in a general hospital towards the care of the mentally ill. The objectives are to determine nurses’ attitude towards care of the mentally ill patients in a general hospital; to describe the demographic characteristics of nurses working in a general hospital and to explore the nurse attitude to the environment in which care is offered to the mentally ill in a general hospital.


A self-administered questionnaire was utilized to explore the attitudes of nurses working in a general hospital. The hospital has a total population of 102 registered and enrolled assistant nurses. The study was conducted with nurses at Princess Margaret hospital that provides medical, surgical, obstetrics and pediatric care and treatment to patients.

The sample was determined using the Raosoft sample size calculator. The margin of error accepted was 5%, confidence level was set at 95%, a distribution response of 50% and a population of 102 (Raosoft, 2004). This resulted in a sample size of 81. However, to take into consideration the rate of attrition and the fact that a number of these nurses are on leave a census sample of the total population of 102 was used. Nurses on leave and nurses who do not wish to participate will be excluded from the study.

Data was collected using a self-administered questionnaire, which consists of 40 items. The study was done in two parts, a selfadministered questionnaire which consists of likert type questions. Section A consist of demographic data and section B contain statements about the nurses’ attitude towards caring for the mentally ill. The attitude questions were adapted from a questionnaire developed by Lethoba [8]. The question asking “I believe that mental illness is caused by “witchcraft” was modified to “I believe that mental illness is caused by “obeah” since the latter term is used in Jamaica.

The data was collected in April - May, 2013 from nurses while they were working on their assigned shift. A consent form explaining the aim of the study and their rights as a participant was given prior to the administering of the questionnaire. Nurses who participated in the study signed the consent form, a copy was given to the participant and one copy was kept by the researcher. The participants were asked not to put their names on the questionnaire. Confidentiality and anonymity was maintained. Each completed questionnaire was placed in an envelope and sealed by the participants. A large envelope was placed on each ward, where each participant placed their sealed envelopes which was kept in a locked cabinet to which only the charge nurse had the key. This was collected daily.

The instrument was pretested among the masters student of the University of the West Indies School of Nursing. Items were refined based on feed-back received from the participants. One question was deleted “Mentally ill patients communicate with body gestures” based on feedback from masters student. Seven (7) items were deleted to improve internal consistency of the scale resulting in a cronbach alpha of 0.79.

Data was analyzed using the Statistical Package for Social Sciences version 20® 2010. This method employs coding of some variables into differences variables and aggregation of attitudinal variables. Tables and bar charts were used to highlight results of the findings. A descriptive analysis using frequency, means and distribution of data was carried out and also looked at correlation between relevant variables, such as age, nursing qualifications and years of experience.

Ethical approval was sought and granted by the UHWI/UWI/ FMS Ethics Committee, Ministry of Health and South East Regional health Authority. Permission was requested and granted by the Chief Executive Officer of the Princess Margaret Hospital. The data collection tool utilized was adapted from a previous study. Participants of the pre-test and main studies confidentiality were respected. Participants were assured that information would be kept confidential and will only be used by the researcher.


Respondents were registered and enrolled assistant nurses who were employed in a general hospital. They had psychiatric training in their nursing education or may have done an additional course in psychiatric nursing. A total of 78 responses (92.8% response rate) were analyzed. Table 1 shows the demographic characteristics of the sample. All the nurses were females with age ranging from 23-64 years. Mean age was 35.7±8.3 years. Most of the nurses (64%) were in the 31-44 year age group. More than half (65%) of the respondents were registered nurses. Regarding nursing qualification, 45% of the registered nurses had a certificate in their specialty. Twenty percent were nurses with bachelor’s degree and were registered nurses. All the enrolled assistant nurses (35%) had diplomas. The data shows that 42% of the respondents had 11-41 years of work experience. Mean years of experience was 9.6±7.7 years (Table 1).