Stigmatizing attitudes in nurses towards people with mental illness: a cross-sectional study in primary settings in Finland

Monitoring Persons' Rights to Equal Care: Registered Nurses' Experiences of Caring for People with Mental Ill-Health and Somatic Comorbidity in Psychiatric Outpatient Care

Persons with severe mental ill-health die early from preventable physical ill-health. Registered nurses in psychiatric outpatient care play a key role in improving persons' physical health, and it is important to examine how they view their responsibility, their experiences of care, and the obstacles they meet in providing person-centred care. The purpose of this study was to explore registered nurses' experiences of caring for persons with mental ill-health and somatic comorbidity in psychiatric outpatient care, using qualitative content analysis to analyze data from semi-structured interviews. The results show that these nurses monitored the person's right to equal care, embraced the whole of the persons suffering, and dealt with unclear boundaries in care. This highlights the unique role that registered nurses play in psychiatric outpatient care via their ability to interpret symptoms and find ways to adapt care based on persons' needs. Registered nurses consider physical health in all care and provide a link between psychiatric and somatic care. Together with mental health nurses at primary health care centers, they are key in reducing persons' suffering. There is a need for structural and functional changes in line with person-centred care including collaboration both within and outside healthcare organizations.

Structural stigma within inpatient care for people who inject drugs: implications for harm reduction

BACKGROUND

 Individuals suffering with addiction have historically experienced disproportionally high levels of stigma. The process of inpatient care for those with substance abuse disorder (SUD) is multifaceted, shaped by the interplay of human interactions within the healthcare team and overarching structural factors like policy. While existing literature predominantly addresses personal and interpersonal stigma, the influence of structural stigma on care delivery practices remains understudied. Our research aims to investigate the impact of structural stigma on care processes for individuals with SUD admitted to acute medicine units.

METHODS

 We conducted a secondary analysis of observation notes and interview transcripts utilizing an analytic framework related to structural stigma adapted from previous research. Data was collected from June 2019 to January 2020 in 2 hospitals. 81 participants consented to observation and 25 to interviews. Interviews were conducted with patients (n = 8), healthcare staff (n = 16), and caregivers (n = 1).

RESULTS

 Each aspect of care for people with SUD is adversely influenced by structural forms of stigma. There was evidence of a gap in accessing care and time pressures which deteriorated care processes. Structural stigma also manifested in the physical spaces designed for care and the lack of adequate resources available for mental health and addictions care. We found that structural stigma perpetuated other forms of implicit and explicit stigma.

CONCLUSIONS

 Structural stigma and other forms of stigma are interconnected. Improving care for people with SUD in hospital settings may require addressing structural forms of stigma such as how physical spaces are designed and how mental healthcare is integrated with physical healthcare within inpatient settings.

Stigmatizing attitudes toward mental disorders among non-mental health nurses in general hospitals of China: a national survey

Background

Negative attitudes of nurses toward mental disorders have been reported in various countries. Nurses' stigmatizing attitudes can harm patients with mental disorders (PWMD), thereby delaying the provision of help to patients and leading to decreased quality of care. In this study, we aimed to assess Chinese nurses' stigmatizing attitudes toward patients with mental illness and provide a basis for future development and testing of appropriate and culturally adapted interventions to reduce it.

Objective

This study aimed to assess the attitudes of Non-mental Health Nurses (NMHNs) in general hospitals in China toward the stigma of PWMD and determine the factors influencing them.

Methods

A cross-sectional survey of NMHNs in general hospitals were conducted. A self-designed WeChat-based questionnaire was used that included demographic information about the need for training on mental health issues. Participants were provided with a vignette of a depression case with suicidal thoughts. The Depression Stigma Scale (DSS) and Social Distance Scale (SDS) were used to assess attitudes toward mental disorders. Nine questions on the adequacy of knowledge about anxiety and depression and the current status of scale use were used to assess the current status of training needs for mental disorders. Descriptive analysis, chi-square test, and multivariate logistic regression were used for the table.

Results

A total of 8,254 nurses in non-mental health professions participated in this study. The mean DSS score of NMHNs was (17.24 ± 6.700), and the SDS score was (10.34 ± 3.154). The total detection rate of stigma among the survey respondents was 13.40% (1,107/8254). Multivariate logistic regression showed that age between 30 and 39 years [p = 0.001, OR = 1.427 (1.154-1.764)], 4 years of work experience and above [p = 0.018, OR = 1.377 (1.056-1.796)], having a bachelor's degree [p < 0.001, OR = 0.742 (0.647-0.851)], adequate psychological knowledge [p < 0.001, OR = 1.567 (1.364-1.799)], full knowledge of communication with patients with anxiety and depression [p < 0.001, OR = 1.848 (1.389-2.459)], and the need to acquire skills to identify anxiety and depression were the influencing factors associated with stigma [p < 0.001, OR = 0.343 (0.236-0.499)].

Conclusion

Stigmatizing attitudes toward PWMD exist among NMHNs in general hospitals in China. Thus, more mental health education programs for NMHNs are needed. Factors associated with higher morbidity stigma can be used to develop appropriate interventions to improve NMHNs' stigmatizing attitudes and provide better quality care to PWMD.

Public health nurses experience of mental health encounters in the context of primary health care: a constructivist grounded theory study

BACKGROUND

In primary health care people with mental health needs are often overlooked or masked with physical complaints. It has been suggested that public health nurses lack sufficient knowledge when encountering people with mental health problems. Low levels of mental health literacy among professionals are associated with negative patient outcome. There is a need to understand public health nurses process and strategies used when encountering a person with mental health problems in order to promote mental health. This study aimed to construct a theory that explains the process of public health nurses experience when encountering people with mental health problems based on their knowledge, attitudes, and beliefs about mental health.

METHODS

A constructivist grounded theory design was used to meet the aim of the study. Interviews were conducted with 13 public health nurses working in primary health care between October 2019 and June 2021, and the data analysis was performed according to the principles of Charmaz.

RESULTS

The core category, "Public health nurses as a relationship builder - to initiate the dialogue" reflected the process while the main categories "Being on your own", "Being on top of things- knowing your limits", and "Professional comfort zone" reflected conditions that were decisive for initiating a dialogue.

CONCLUSION

Managing mental health encounters in primary health care was a personal and complex decision-making process that depends on the public health nurses' professional comfort zone and acquired mental health literacy. Narratives of the public health nurses helped to construct a theory and understand the conditions for recognizing, managing and promoting mental health in primary health care.

District Nurses' Experiences of Practice in Caring for People with Mental Ill-Health in Swedish Primary Care

Mental ill-health is one of the greatest public health challenges in Sweden, and it is estimated that every third person seeking primary care in the country suffers from mental ill-health. Without proper treatment at an early stage, mental ill-health may lead to long-term illness and have a significant impact on functional ability. As district nurses are specialists in public health nursing, they have been pointed out as having a key role in the prevention and management of mental ill-health. The aim was to explore district nurses' practice in caring for people with mental ill-health within primary health care. Individual semi-structured interviews were conducted with district nurses (n = 18) and the transcribed text was subjected to qualitative content analysis. The result was formulated as several subthemes, eventually developed into three themes: Practicing within an organisation where traditional attitudes are impediments, Perceiving mental healthcare as not being an obvious part of district nursing, Working as fellow human beings rather than "professionals". The findings indicate that district nurses feel uncertainty in their practice in this area. Working independently with mental ill-health was not always considered socially acceptable among district nurses. Despite these challenges they tried to remain involved without becoming emotionally overwhelmed. They also strived to meet the needs of these patients with 'small things', that could be effective and a part of recovery-oriented practice, even if they might be defined as unprofessional, and their efficacy negated.

Stigma towards patients with mental illness: An online survey of United States nurses

People with mental illness experience significant health disparities, including morbidity and premature mortality. Evidence suggests that stigma is a contributing factor to these observed inequities. The tripartite conceptualization of stigma proposes that three problems underlie stigma: problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). There is limited prior research concerning stigma towards mental illness among nurses in the United States (US). The aims of this study were to assess stigma among US nurses towards patients with mental illness, compare the stigma expressed by nurses working in medical/surgical settings with mental health settings, and identify factors associated with stigma. Participants were recruited online from national professional nursing organizations in the US. We collected demographic data and administered measures of mental health stigma and stigma-related mental health knowledge. Mental health nurses demonstrated comparatively lower levels of stigma and higher levels of knowledge than the medical/surgical nurses. Nursing speciality and personal contact with mental illness were the most significant predictors of stigma and knowledge. Knowledge was found to partially mediate the relationship between nursing speciality and stigma. We found support for the 'contact hypothesis', that is, having a personal experience of mental illness or a friend or family member who has a mental illness is associated with lower stigma towards mental illness. These findings support the development of contact-based and educational anti-stigma interventions for nurses in order to reduce stigma towards mental illness.

Nurses' Experiences of Suicide Prevention in Primary Health Care (PHC) - A Qualitative Interview Study

AIM

The purpose was to describe nurses' experiences of suicide prevention work in primary health care (PHC).

BACKGROUND

Suicide is the tenth most common cause of death among adults. PHC has an important role in suicide prevention work, as patients often had contact with PHC before their suicide rather than with specialist psychiatric care. Nurses often have the first contact with the patient and are responsible for triage and assessment, making them important in suicide prevention work. Previous studies shed light on suicide prevention in a primary care context, but the nurses' voices are missing.

METHODS

Fifteen qualitative interviews were conducted with nurses in primary health care. Data was analyzed according to conventional content analysis techniques.

FINDINGS

Nurses may avoid asking questions about suicidality for fear of what to do with the answer. To support the nurses' ability in suicide prevention work, both educational and practical experience are fundamental. There was a lack of clarity about who is carrying responsibility for the patient, and it turned out to be difficult to help the patient move further to the next care institution. There was a need for guidelines as well as routines for collaboration with other care actors in suicide prevention work.

CONCLUSION

The PHC organization does not support nurses in suicide prevention, therefore they need the right conditions for their work. Suicide prevention needs to be given greater focus and space within education as well as training in the ongoing clinical work, which can be performed with less extensive efforts.

Stigma towards people with mental illness in the Nordic countries - a scoping review

INTRODUCTION

Stigma affects people with mental illness globally, however, it is proposed that stigma is less prevalent in wealthier countries and that people hold more positive attitudes in Northern and Western Europe. Even so, accounts from surveys in Denmark and Sweden reveal that stigma is very much prevalent.

AIM

This scoping review aims to shed light on the body of literature regarding mental-health-related stigma in the Nordic Countries and identify knowledge gaps.

METHODS

We searched four electronic databases in December 2017 and again in June 2020. All types of empirical studies (qualitative, quantitative, and mix-methods) examining the stigma of people with mental illness were included.

RESULTS

In total, 61 studies were included. Overall, findings from the Nordic countries resemble global findings. Studies are primarily descriptive, and mostly survey studies of attitudes toward people with mental illness in the general population. Few studies focus on discrimination, and those who do, measure intended behavior in hypothetical situations rather than actual acts of discrimination in real-life situations. Studies were mostly conducted on a community or organizational level; no studies were identified on a system level. Experienced stigma and discrimination by patients, but also relatives, were a focus in one-third of the studies. Very few studies of interventions to reduce stigma and discrimination were identified.

CONCLUSION

More studies into stigma on a system or institutional level are needed. Ways to measure acts of discrimination should be invented. Furthermore, interventions to reduce stigma and discrimination should be developed, targeting all levels of society.

Anti-stigma initiatives for mental health professionals-A systematic literature review

WHAT IS KNOWN ON THE SUBJECT?: Negative attitudes towards mental illness lead to the formation of stigma. Stigma prevents the recovery of people diagnosed with mental illness. There is evidence of stigmatic attitudes towards mental ill health among mental health professionals. Anti-stigma initiatives, such as education and training, may be effective in enhancing or maintaining positive attitudes towards mental illness among mental health professionals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Education and training that is designed and delivered around a specific mental health diagnosis or condition appears an appropriate strategy that could benefit mental health professionals to develop a deeper appreciation and understanding of mental ill health and its impacts on individuals. Consumer involvement in the education and training of mental health professionals regarding the stigma of mental illness is recommended; however, this is an under-explored area of investigation. There is a weak evidence base regarding the long-term sustainability of effects from anti-stigma education and training. This should be addressed via further research in future. WHAT ARE THE IMPLICATIONS FOR PRACTICES?: Anti-stigma initiatives can support mental health professionals to develop stigma-free, recovery-oriented practices in their work. Further, such initiatives can improve the provision of evidence-based quality care for the consumers, facilitating their recovery. ABSTRACT: Introduction Despite an increasing focus on stigma, evidence shows prejudicial attitudes towards mental illness among mental health professionals still exist. It is suggested that anti-stigma initiatives can aid in enhancing the attitudes of mental health professionals. However, research on initiatives targeting stigma of mental illness among mental health professionals is limited. Aim To identify and analyse scientific literature pertaining to the effectiveness of anti-stigma initiatives regarding mental ill health among mental health professionals. Method A systematic literature review was performed using the databases MEDLINE, CINAHL, PsycINFO, PubMed, Scopus, Google Search engine and Google Scholar. The papers were limited to English language, published in peer-reviewed journals with full-text articles available and published between the years 2008 and 2020 to understand the most recent trends in the attitudes of mental health professionals including nurses. The Population, Intervention, Comparison and Outcome (PICO) strategy was used to identify papers meeting the inclusion criteria. Results A total of 439 papers were identified. However, papers not meeting the inclusion criteria were excluded from selection. Three appraisers reviewed the selected papers individually using the Joanna Briggs Institute [JBI] critical appraisal tool. Finally, eight unanimously accepted papers were included in the systematic review. Several effective anti-stigma initiatives were identified through the review, and these had positive impacts on mental health professionals' attitudes towards mental illness, for at least a short period. It was identified that contact-based interventions are relevant and effective although the involvement of consumers and caregivers in the design and delivery of interventions was not explicitly addressed in detail in studies included in the review. Education strategies tailored for specific mental illness may be more appropriate, rather than approaches that refer to mental illness in general. Conclusions This review shows the evidence of pessimistic attitudes towards mental illness persists among mental health professionals. Anti-stigma initiatives identified in the selected papers were effective in changing these attitudes. Future research should be focused on the effectiveness of contact-based interventions and understanding the longer-term effects of the interventions among homogeneous groups. Full consideration of the varying level of clinical experience and expertise in mental health should guide the development and implementation of anti-stigma initiatives in this context. Implications for practice Anti-stigma interventions can have a positive impact on mental health professionals' knowledge, attitudes and supportive caring for people diagnosed with mental illness. Such anti-stigma interventions may meaningfully support stakeholders to address the impact of negative attitudes on the physical and mental health status of people diagnosed with mental illness. With sustained leadership, effort and reinforcement, it is possible to create workplace cultures that prioritize stigma-free and recovery-oriented behaviours and practices within mental health services.

Healthcare Professionals' Attitudes Toward Patients With Mental Illness: A Cross-Sectional Study in Qatar

BACKGROUND

Negative attitudes toward mental illness by Health Care Professionals (HCP) have been reported in many countries across the world. Stigmatizing attitudes by HCP can have adverse consequences on people with mental illness from delays in seeking help to decreased quality of care provided. Assessing such attitudes is an essential step in understanding such stigma and, if needed, developing and testing appropriate and culturally adapted interventions to reduce it.

AIMS

To assess physicians and nurses attitudes toward mental illness and to determine associated factors with different levels of stigma.

METHODS

A cross-sectional survey was conducted among Physicians and Nurses. The Mental Illness Clinician's Attitudes (MICA) scale was used to assess attitudes toward mental illness. MICA scores range between 1 and 6 with higher values indicating higher stigmatizing attitudes. Demographic and work related information were also gathered. Descriptive statistics along with multivariate linear and multivariate logistic regression models were used.

RESULTS

A total of 406 nurses and 92 doctors participated in the study. The nurses' mean MICA score was significantly higher than that of the physicians. Among nurses, being Asian and working in a geriatric, rehabilitation and long-term care facility were associated with lower MICA scores. Among physicians, being female or graduating more than 1 year ago were also associated with lower MICA scores.

CONCLUSION

Stigmatizing attitudes toward people with mental illness by healthcare workers are present in Qatar. They are higher among nurses as compared to physicians. Factors associated with higher stigmatizing attitudes could be used in creating appropriate intervention to reduce the magnitude of the problem.

Somatic health care professionals' stigmatization of patients with mental disorder: a scoping review

BACKGROUND

Patients with mental disorders have an increased risk of developing somatic disorders, just as they have a higher risk of dying from them. These patients often report feeling devaluated and rejected by health professionals in the somatic health care system, and increasing evidence shows that disparities in health care provision contribute to poor health outcomes. The aim of this review was to map and synthesize literature on somatic health professionals' stigmatization toward patients with mental disorders.

METHODS

We conducted a scoping review using Arksey and O'Malley's framework and carried out a systematic search in three databases: Cinahl, MEDLINE, and PsycINFO in May-June 2019. Peer-reviewed articles published in English or Scandinavian languages during 2008-2019 were reviewed according to title, abstract and full-text reading. We organized and analyzed data using NVivo.

RESULTS

A total of 137 articles meeting the eligibility criteria were reviewed and categorized as observational studies (n = 73) and intervention studies (n = 64). A majority of studies (N = 85) focused on patients with an unspecified number of mental disorders, while 52 studies focused on specific diagnoses, primarily schizophrenia (n = 13), self-harm (n = 13), and eating disorders (n = 9). Half of the studies focused on health students (n = 64), primarily nursing students (n = 26) and medical students (n = 25), while (n = 66) focused on health care professionals, primarily emergency staff (n = 16) and general practitioners (n = 13). Additionally, seven studies focused on both health professionals and students. A detailed characterization of the identified intervention studies was conducted, resulting in eight main types of interventions.

CONCLUSIONS

The large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behavior toward specific mental disorders.

Effect of brief social contact video compared with expert information video in changing knowledge and attitude towards psychosis patients among medical students

OBJECTIVE

Direct contact interventions are known to reduce stigma. Effects of both filmed and direct social contact were found similar in reducing stigma. This study aims to understand the effect of video intervention, especially the effects between patient-sharing video and expert information video, among the medical students.

METHODS

Seventy-two medical students were recruited from two consecutive clinical study periods. Students from one period were in the patient-sharing group, watching a 7-minute patient-sharing video. The others were in expert information group watching a 5-minute psychosis video. Subject's desire of social distance (Reported and Intended Behaviour Scale) knowledge (the Social Contact Intended Learning Outcome) attitude towards mental illness (Clinicians Attitudes Scales version 4) and emotional reactions (the Emotional Reactions to Mental illness Scales) were measured. Assessments were done at baseline, immediately after video watching and at 1 to 2 weeks follow-up. Within-group ANOVA was used to assess the difference between time points. Group by time effect was explored.

RESULTS

Significant improvement in knowledge level was found with a significant group by time effect (F = 6.261, P = .004) for PS group and was maintained at follow-up. Post-intervention attitude was significantly improved in PS group but not maintained. Only social distance was improved significantly in EX group (F = 8.093, P = 0.003). Both groups had a significant reduction in fear sub-score.

CONCLUSION

This study provided evidence on the effect of patient-sharing video in improving the attitude and knowledge of medical students. Expert information video about psychosis can improve social proximity. Combining these approaches may improve stigma and knowledge among medical students.

Brief training in child and adolescent mental health: Impact on the knowledge and attitudes of pediatric nurses in Nigeria

PROBLEM

Poor knowledge and stigmatizing attitudes of healthcare professionals constitute a significant barrier to child and adolescent mental health care worldwide. This study aimed to determine the effect of a training intervention on the knowledge and attitudes of pediatric nurses to child mental health problems at a Nigerian tertiary hospital.

METHODS

A two group pretest-posttest study design was undertaken. A total of 156 pediatric nurses were recruited, and participants in the intervention group received a brief child mental health training based on the World Health Organization's mhGAP training manual. Knowledge and attitudes to child mental health problems were obtained at baseline, and post intervention.

FINDINGS

There were no differences in knowledge or attitudes across the two groups at baseline. Post intervention, there was a significant increase in the mean post knowledge scores of the intervention group compared with the control group (t = 3.8, p < .001). The effect size of the intervention was 0.62. There were no significant differences in mean post attitude scores across groups.

CONCLUSION

Incorporating children and adolescents mental health competencies into the training of nurses had a modest effect on their knowledge, but limited effect on their attitudes.

Reliability and Validity of the Chinese Version of the Scale for Assessing the Stigma of Mental Illness in Nursing

Background: The prevalence of mental illness continues to increase in China, but research on stigma is still in its infancy, and there are even fewer studies on stigma among nurses. A comprehensive, effective and reliable tool is needed to assess stigma in nursing so that it can be reduced or eliminated to improve nursing quality. This study aimed to translate a 20-item scale for assessing the stigma of mental illness in nursing into Chinese and evaluate its reliability and validity. Methods: An improved Brislin translation model was used to translate the nursing mental illness stigma assessment scale into Chinese. Content and face validity were determined by a panel of experts. A convenience sample of 501 nursing students was chosen. Confirmatory factor analysis, concurrent validity and known group comparison were used to evaluate the scale's structural validity. The reliability was evaluated based on the internal consistency reliability and 2-week retest reliability. Results: The content validity index was 0.90. Confirmatory factor analysis showed that this study supported the three-factor model. The moderate correlation between the Chinese version of the Scale for Assessing the Stigma of Mental Illness in Nursing and the Perceived Devaluation Discrimination Scale suggested acceptable concurrent validity. Cronbach's α (0.863) and the retest coefficient (0.839) were indicative of internal consistency. Conclusion: The Chinese version of the Scale for Assessing the Stigma of Mental Illness in Nursing has acceptable concurrent validity, marginal factor validity, and satisfactory reliability in China. Therefore, the three-factor structure of the Chinese scale should be considered. Relevance to Clinical Practice: The Chinese version of the Scale for Assessing the Stigma of Mental Illness in Nursing can be used to understand the degree of mental illness stigma in nursing.

Investigating Nurses' Views on Care of Mentally Ill Patients with Skin Injuries

Background: Individuals with mental illness are at increased risk of skin injuries. The role of nurses in skin injury prevention and management is crucial and therefore their views on wound care may provide useful information for improving the quality of the care provided. Aim: To investigate nurses’ views on care of mentally ill patients with skin injuries. Method: A qualitative research design based on the principles of grounded theory approach was followed. Unstructured interviews were conducted with seven nurses working in psychiatric wards with frequent skin injuries. Data were analyzed using the constant comparative method of analysis. Results: Two main themes were emerged from data analysis. The first main theme, namely factors affecting the care of patients with skin injuries, included seven categories: (a) shortage of hospital supplies, equipment and services (b) staff shortages, (c) lack of knowledge, (d) nurses’ resistance to change, (e) difficulty in collaborating with patients, (f) patients’ physical conditions and (g) nurses’ attitudes as an obstacle to care. The second main theme, namely nurses’ suggestions for optimizing care, included five categories: (a) need for additional staff, (b) need for increasing hospital supplies and equipment availability, (c) need for training (d) need of changing nurses’ attitudes towards care and (e) need of changing the patients’ approach to collaboration. Conclusion: The care of mentally ill patients with skin injuries is affected by multidimensional factors that have a direct impact on the quality of nurses’ work and patients’ hospitalization. Specific efforts are needed to overcome the obstacles that hinder the care provided and to improve clinical practice.

Development and psychometric testing of a scale for assessing the associative stigma of mental illness in nursing

AIMS AND OBJECTIVES

To develop a new scale for assessing the associative stigma of mental illness in nursing based on Peplau's model of psychodynamic nursing and to examine its psychometric properties.

BACKGROUND

The stigma of mental illness continues to cause problems today for patients, families and mental health professionals. For individuals with a mental disorder, stigma can result in restricted opportunities, social exclusion and the denial of rights. Associative stigma in mental health professionals is becoming a major problem and is related to increased depersonalisation, higher levels of emotional exhaustion and diminished job satisfaction among mental health professionals. Nursing may play a key role in reducing the stigma associated with mental illness, but there are no specific scales for the measurement of associative stigma in nursing.

DESIGN

Development of an instrument. A STROBE checklist was completed.

METHODS

This study involved two stages: (a) item generation and content validation; (b) examining the reliability and convergent/discriminant validity of the scale. A developmental and methodological design was used. Data were collected between November 2016-December 2017 from a sample of 737 nursing undergraduates.

RESULTS

The results indicated good internal consistency for the final 20-item scale for assessing the associative stigma of mental illness in nursing, which is considered in terms of three dimensions: Violence/Dangerousness, Disability, and Irresponsibility/Lack of Competence. Exploratory and confirmatory factor analyses supported a three-factor structure consistent with the theoretical model.

CONCLUSIONS

The 20-item EVEPEM (from its Spanish acronym) derived from Peplau's theory was shown to be a valid and reliable tool for assessing the stigma of mental illness in the nursing setting.

RELEVANCE TO CLINICAL PRACTICE

Reliable instruments are needed to measure the effectiveness of anti-stigma interventions for mental health professionals. The results indicate that the tool developed is a valid and reliable instrument for use in the nursing setting.

"Somebody else's business": The challenge of caring for patients with mental health problems on medical and surgical wards

WHAT IS KNOWN ON THE SUBJECT?: People with mental health problems have higher rates of physical health concerns and hospital admissions than those without mental health problems. These patients have poorer outcomes from surgery and have worse experiences of care when admitted for medical or surgical procedures. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper looks to understand why care may be poorer for patients with mental health problems by speaking to staff providing care in these settings. We spoke to 30 general hospital staff about mental health on the wards and found that a lack of leadership and ownership for prioritising mental health led to people not seeing it as their job, and that it was somebody else's business to manage that side of care. We also found that the emotional effect of caring for people who had attempted suicide or had self-harm injuries was difficult for staff, impacting on staff well-being and leading them to distance themselves from providing care in those cases. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is a need for staff to be supported from the top-down, with management providing clear leadership around issues and pathways for mental health needs so they know the best way to provide care and encourage collaborative working. In addition, bottom-up support is needed to help staff personally manage their own well-being and mental health, including supervision and debriefing from mental health specialists to improve understanding from the patient's perspective and to provide emotional support to manage difficulties. RELEVANCE STATEMENT: This paper places focus on the care of patients with mental health problems in medical and surgical care settings highlighting the interplay between mental and physical health from a perspective that is less often explored. This paper provides insights into the multidisciplinary nature of nursing and the need for integrated care. This provides findings that build a picture of how mental health nursing specialism is needed beyond psychiatric wards and within medical and surgical settings. ABSTRACT: Introduction Evidence shows that patients with mental health problems have poorer physical health outcomes, increased mortality and experience poorer care during surgery and medical admissions. Issues related to lack of training, stigmatizing attitudes, fear or hopelessness may help understand these poor outcomes. Aim To explore the experiences of staff in providing care for people with mental health problems. Method A qualitative service evaluation approach was used. Participants working in an acute care hospital in inner-city London were recruited across professions and job levels using a self-selection sampling method. A total of 30 participants took part in semi-structured interviews (n = 17) and two focus groups (n = 13), and data were thematically analysed. Relevant organizational documents and service use data were utilized to inform the evaluation. Results Key themes were organized across the macro, meso and micro levels to understand the levels of disconnection and silence around mental health in acute care. Themes include systemic factors surrounding the institutional culture, ward cultures and collaborative working, and individuals' sense-making of mental health and personal well-being. Implications for practice These findings signpost the growing need for greater mental health nursing input on medical and surgical wards and within these teams to provide informed knowledge, support and supervision.

Stigma for Mental Disorders among Nursing Staff in a Tertiary Care Hospital

Objective  This study aimed to evaluate the prevalence of stigma for mental disorders among nursing staff in a tertiary care hospital, and the secondary objective of the study was to assess the correlation of stigma with the socio-demographic profile and previous experience with mentally ill patients. Methods  This cross-sectional study was performed among the 210 nurses working in a tertiary care multispecialty teaching public sector hospital in north India. They were evaluated on community attitudes toward the mentally ill (CAMI) scale. Results  About two-thirds of the participants (67.1%) were females and had done graduation (64.2%) in nursing. Nearly 50% of the study participants had an experience of working with mentally ill patients. Female had a more significant positive attitude on the domain of social restrictiveness. Authoritarianism had a significant positive correlation with benevolence and social restrictiveness domains. The benevolence domain had a significant correlation with all other domains. Social restrictiveness domain also had a significant correlation with other domains. Conclusion  Nurses have a positive attitude toward mentally ill patients.

The effect of psychiatric nursing students' internships on their beliefs about and attitudes toward mental health problems; a single-group experimental study

BACKGROUND

It is important that nursing students develop positive beliefs and attitudes toward individuals with mental health problems during nursing education in order to provide an effective nursing care and create a therapeutic environment.

OBJECTIVE

This study was conducted to analyze the effect of psychiatric nursing internship practice and the personal characteristics and preferences of psychiatric nursing interns on their beliefs and attitudes toward mental illnesses.

DESIGN

This is a single group experimental study with a pre-test and post-test.

PARTICIPANTS

The study sample included 33 fourth-year nursing students enrolled in the School of Health who participated in an internship in psychiatric nursing.

METHODOLOGY

The study data were collected using a student information form, the Community Attitudes Toward the Mentally Ill Scale (CAMI) and the Beliefs Toward Mental Illness Scale (BMI) at the beginning and end of the 14-week internship of 32 h per week.

FINDINGS

The students' beliefs and attitudes toward mental health problems were found to be moderate with no significant differences between mean pre-test and post-test scores.

CONCLUSION

The psychiatry nursing internship practice yielded minimal positive changes in students' beliefs and attitudes toward mental health problems. Initiation of the process of developing positive attitudes and beliefs in the first year of nursing education and increasing the internship period may provide more effective results.

'It is meant to be heart rather than head'; International perspectives of teaching from lived experience in mental health nursing programs

Consumer participation is a clear expectation of contemporary mental health policy. Most activity has concentrated in direct service delivery, and academic roles for mental health consumers have been slow to establish. An international project was undertaken to implement and evaluate meaningful consumer involvement in mental health nursing education. A learning module was co-produced between 'Experts by Experience' (drawing on experience of mental distress and service use) and Mental Health Nurse Academics. This qualitative exploratory study aimed to capture how Experts by Experience perceive their contribution. Interviews were undertaken with Experts by Experience who delivered the learning module. Data were analysed thematically and subsequently interpreted with Critical Social Theory. Two main themes emerged from the findings: 'there wasn't a barrier' described how personal narratives enhanced relationships between Experts by Experience and students; and 'made the human being visible', described their experiences of allowing students to see the person behind a diagnosis. These findings suggest Experts by Experience teaching is valuable and potentially a tool in redressing stigma. Addressing poor public perceptions could attract higher numbers of quality practitioners to mental health and meet identified workforce shortages. The findings presented here strengthen the evidence base for Expert by Experience roles in mental health professional education. These findings can be considered in international curricula reviews and aid progress towards a more socio-political, humanistic focus in mental health nursing, congruent with rights-based reform agendas.

Factors Associated With Primary Family Caregivers' Perceptions on Quality of Family-Centered Care in Mental Health Practice

PURPOSE

This study aimed to examine the quality of family-centered care perceived by primary family caregivers and its influencing factors in mental healthcare practice.

DESIGN

A cross-sectional, correlational study.

METHODS

A convenience sample of 121 mental health nurses and 164 primary family caregivers of patients with schizophrenia was recruited from acute psychiatric wards and chronic psychiatric rehabilitation wards in three psychiatric hospitals in Taiwan. Structured questionnaires for mental health nurses were designed to examine nurses' attitudes toward schizophrenia and the importance of families in nursing care. Primary family caregivers were assessed to determine their perceptions of quality of family-centered care. At least one primary family caregiver of patients was matched to a nurse who took major responsibility for the patient during the hospitalization. Data were analyzed with descriptive statistics, Pearson's product-moment correlations, independent t-test, one-way analysis of variance, and stepwise regression analyses.

RESULTS

Quality of family-centered care perceived by primary family caregivers regarding the provision of general and specific information, as compared to enabling and partnership, coordinated and comprehensive care, and respectful and supportive care, was relatively inadequate. Younger and more educated primary family caregivers, having relatives with schizophrenia in acute wards, less supportive nurses' attitudes toward schizophrenia, and the importance of family in nursing care were correlated with poor primary family caregivers' perceptions of quality of family-centered care. Nurses' supportive attitudes toward schizophrenia and chronic psychiatric rehabilitation wards where patients received care were key factors in determining better quality of family-centered care.

CONCLUSIONS

Findings provide a platform for the development of effective continuing education and training programs to equip mental health nurses with supportive attitudes toward mental illness and an integration of the family in nursing care, which will ultimately improve mental health care for families experiencing mental health problems.

CLINICAL RELEVANCE

Efforts in professional training to address stigma and encourage a family-centered approach into recovery-oriented practice for practicing mental healthcare providers, including mental health nurses, are recommended.

Opinions on mental illness from the perspective of primary care nurses in Portugal

Abstract Objective: To identify the opinions of primary care nurses regarding mental illness and the care provided to this population. Methodology: Cross-sectional, quantitative study with the participation of 328 nurses of primary health care in Porto, Portugal. Data collected between April and August of 2018 through the scale "Opinions about Mental Illness" and socio demographic and labor questionnaire. Descriptive and correlational statistics were applied. Results: A total of 50% of the nurses presented positive opinions about the mental illness. Regarding the assistance provided in their unit of action, 53.4% considered inadequate and 50.3% recognized as adequate their knowledge about the role that primary health care has in assisting the person with mental illness. Conclusion: Positive opinions and recognition of the importance of primary care to people with mental illness are important indicators for qualified mental health care outside the field of specialty.

Self-Stigma Experiences Among Older Adults with Mental Health Problems Residing in Long-Term Care Facilities: A Qualitative Study

Self-stigma is linked with a variety of deleterious consequences for the stigmatised individual. Much of the past research on self-stigma focuses on younger adults; however, little is known about the self-stigma experience among institutionalised older adults with mental health problems. This study aims to explore experiences of self-stigma among older adults with mental health problems in long-term care facilities. Ten semi-structured interviews were conducted. Insight into mental illness was identified as having a key influence upon the self-stigma experiences among this group. Participants shared common understandings, views, and behavioural reactions towards mental health problems. Lacking control, public stigma, sympathy, disinterest, avoidance, and fear were key themes among them. Re-conceptualising self-stigma theories and implementing interventions that aim at reducing stigmatising attitudes among this group are essential.

Stigma towards mental illness and substance use issues in primary health care: Challenges and opportunities for Latin America

Stigma towards mental illness and addictive disorders is a global problem and one of the main obstacles in tackling this issue remains the effective integration of mental health services into primary health care (PHC). In Latin America, information has significantly increased on the existence of stigma; however, little is known about effective interventions to prevent stigma and promote recovery-oriented practices in PHC. The aim of this study is to understand the existing evidence regarding mental health stigma in PHC with a special focus on the Latin American region. A scoping review of the literature related to mental health stigma in PHC was conducted. Two hundred and seventeen articles were evaluated; 74 met inclusion criteria and 14 additional articles were selected from references of search results. Results were subdivided into five different perspectives: users, family members and significant others, health professionals, contextual factors, and potential effective interventions. Only nine studies were based in Latin America, and only one described an intervention to reduce stigma in mental health services, not specifically in PHC. We found an urgent need to develop interventions to understand and reduce stigma in PHC settings, especially in Latin America.