PROGRAMME ON KNOWLEDGE AND ATTITUDE REGARDING INTEGRATION OF MENTAL HEALTH NURSING CONCEPTS AMONG NURSES AT SELECTED
SETTING, CHENNAI.
DISSERTATION SUBMITTED TO
THE TAMILNADU DR.M.G.R.MEDICAL UNIVERSITY CHENNAI.
IN PARTIAL FULFILMENT OF REQUIREMENT FOR THE DEGREE OF
MASTER OF SCIENCE IN NURSING
APRIL 2012
PROGRAMME ON KNOWLEDGE AND ATTITUDE REGARDING INTEGRATION OF MENTAL HEALTH NURSING CONCEPTS AMONG NURSES AT SELECTED
SETTING, CHENNAI.
Certified that this is the bonafide work of Ms. SHEEBA GRACELIN.B OMAYAL ACHI COLLEGE OF NURSING,
#45, AMBATTUR ROAD, PUZHAL, CHENNAI – 600 066.
COLLEGE SEAL
SIGNATURE: _________________
Dr.(Mrs).S.KANCHANA
B.Sc.(N)., R.N., R.M., M.Sc.(N)., Ph.D., Principal & Professor of Nursing,
Omayal Achi College of Nursing, Puzhal, Chennai – 600 066, Tamil Nadu
Dissertation Submitted to
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY CHENNAI.
In partial fulfilment of requirement for the degree of MASTER OF SCIENCE IN NURSING
APRIL 2012
REGARDING INTEGRATION OF MENTAL HEALTH NURSING CONCEPTS AMONG NURSES AT SELECTED
SETTING, CHENNAI.
Approved by Research Committee in December 2010.
RESEARCH DIRECTOR
Dr.(Mrs).S.KANCHANA __________________________
B.Sc.(N)., R.N.,R.M., M.Sc.(N)., Ph.D., Principal & Professor of Nursing,
Omayal Achi College of Nursing,
Puzhal, Chennai – 600 066, Tamil Nadu.
CLINICAL SPECIALITY- HOD
Prof.CIBY JOSE __________________________
B.Sc.(N)., R.N., R.M., M.Sc.(N)., Ph.D.,
Head of the Department, Department of Psychiatric Nursing,
Omayal Achi College of Nursing,
Puzhal, Chennai – 600 066, Tamil Nadu.
CLINICAL SPECIALITY- RESEARCH GUIDE
Mrs.JEAYAREKA.J __________________________
B.Sc.(N)., R.N., R.M., M.Sc.(Psy)., M.Sc.(N)., Lecturer, Department of Psychiatric Nursing,
Omayal Achi College of Nursing, Puzhal, Chennai – 600 066, Tamil Nadu.
MEDICAL EXPERT
Dr.R.SATHIANATHAN ___________________________
M.D., D.P.M M.P.H., (U.S.A) Professor, Madras Medical College,
Senior Civil Surgeon,
Govt.Gen Hospital, Chennai-3, Tamil Nadu
Dissertation Submitted to
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY
CHENNAI
In partial fulfilment of requirement for the degree of
MASTER OF SCIENCE IN NURSING
APRIL 2012
At the outset, I the investigator of the study would like to extend my heartful thanks and gratitude to the Managing Trustee, Omayal Achi College of Nursing who have given me an opportunity to do post graduate education in nursing.
I express my sincere thanks to Dr.Rajanarayanan, B.Sc., M.B.B.S., FRSH [London], Research co coordinator ICCR PHC , Honorary Professor in Community Medicine for the valuable suggestion and guidance throughout the study .
I am extremely grateful to Dr.Mrs.S.Kanchana, Principal, Omayal Achi College of Nursing, for her constant source of inspiration and encouragement throughout the study.
I express my humble gratitude to Prof.(Mrs).Celina, Vice principal, Omayal Achi College of Nursing, for her valuable guidance and support during the study .
I am greatly indebted to express my heartfelt thanks to Committee Members of ICCR, Omayal Achi College of Nursing, for their expert guidance for the study.
I extend my earnest gratitude to Prof.Ciby Jose, Head of the Department, Mental Health Nursing, for her expert guidance for the study.
I owe my profound gratitude and exclusive thanks to my Research guide Ms.Jeayareka.J, Lecturer of Mental Health Nursing Department for her constant encouragement, suggestions and guidance throughout the study.
I am obliged to Ms.Hemalatha.J, Mrs.P.Jayanthi, Mrs.M.Darjilin, Mrs.S.Kalaiyarasi, lecturers of Mental Health Nursing Department for their timely help, constant inspiration and patient endurance.
I acknowledge my sincere gratitude to Mr.Venkatesan, Biostatistician for his help in statistical analysis of the study.
I thank all the Nurses of Sundaram Medical Foundation who had participated in the study and had given their full support and co-operation throughout the study.
I express my sincere thanks to Mr.Allwyn Prem Raj for peer evaluating my dissertation.
I am thankful to all the experts in the field who have given their valuable guidance and suggestions in validating the tool for the study.
I extend my thanks to the Librarians of Omayal Achi College of Nursing and The Tamil Nadu Dr.M.G.R.Medical University, for their co-operation in collecting the related literature for this study.
I extend my sincere gratitude to Mr.G.K.Venkataraman, Elite Computers for his efforts and cooperation in completing the manuscript.
I am grateful to my beloved parents Mrs. and Mr.Benjamin Jayaraj for their constant encouragement, support and sincere prayers to make my study a successful one.
Above all, I thank God The Almighty for His blessings and sustaining me in the course of my endeavour.
CHAPTER CONTENTS PAGE NO.
I
II III
ABSTRACT INTRODUCTION Background of the study Need for the study Statement of the problem Objectives
Operational Definition Assumptions
Null hypotheses Delimitation
Conceptual framework Outline of the study report REVIEW OF LITERATURE Review of related literature
RESEARCH METHODOLOGY Research approach
Research design Variables
Setting of the study Population
Sample
Criteria for sample selection Sample size
Sampling technique
1 4 6 7 7 8 8 9 9 13
14
26 26 27 27 27 27 27 28 28
IV
V VI
Content validity Ethical consideration Pilot study
Reliability
Procedure for data collection Plan for data analysis
DATA ANALYSIS AND INTERPRETATION Organization of data
Presentation of data DISCUSSION
SUMMARY, CONCLUSION, IMPLICATIONS, RECOMMENDATIONS AND LIMITATIONS BIBLIOGRAPHY
APPENDICES
32 32 34 35 35 36
38 39 52 57
63 i – lvi
TABLE NO.
TITLE PAGE NO.
1(a) Frequency and percentage distribution of demographic variables of nurses in group A and group B with respect to age in years, gender and religion.
39
1(b) Frequency and percentage distribution of demographic variables of nurses in group A and group B with respect to marital status, education and designation
40
1(c) Frequency and percentage distribution of demographic variables of nurses in group A and group B with respect to total years of experience and area of work
41
2 Comparison of level of need for in – service education programme regarding integration of mental health nursing concepts between group A and group B
43
3 Frequency and percentage distribution of post test level of knowledge regarding integration of mental health nursing concepts on various aspects in group A and group B
44
4(a) Comparison of post test knowledge score regarding integration of mental health nursing concepts between group A and group B
47
4(b) Comparison of post test attitude score regarding integration of mental health nursing concepts between group A and group B
48
FIGURE NO. TITLE PAGE NO.
1 Modified Conceptual Framework Based On Wiedenbach’s Helping Art Of Clinical Nursing Theory
12
2 Frequency and percentage distribution of level of need for in-service education programme regarding integration of mental health nursing concepts among nurses in group A and group B.
42
3 Frequency and percentage distribution of post test level of knowledge regarding integration of mental health nursing concepts in group A and group B
45
4 Frequency and percentage distribution of post test level of attitude regarding integration of mental health nursing concepts in group A and group B.
46
5 Correlation between post test knowledge and attitude regarding integration of mental health nursing concepts score in group A
49
6 Correlation between post test knowledge and attitude regarding integration of mental health nursing concepts score in the group B
50
APPENDIX TITLE PAGE NO.
A Ethical Clearance Certificate i
B Letter seeking and granting permission for
conducting the study ii
C
Letter seeking experts’ opinion for content validity List of experts for content validity
Content validity certificates
iii iv v - ix
D Certificate of English editing x
E Informed Consent
- English xi
F
Copy of the tool for data collection Section I : Demographic Variables Section II : Need Assessment
Section III : Structured Knowledge questionnaire Section IV : Four point likert scale to assess attitude
xiii xv xvi xxii
G Plagiarism Report xxiv
H Coding for demographic variables xxv
I Blue print xxvii
J Intervention tool – Structured teaching plan
Lesson Plan - English xxviii - lvi
A quasi - experimental study to assess the effectiveness of in-service education programme on knowledge and attitude regarding integration of mental health nursing concepts among nurses at selected setting, Chennai.
INTRODUCTION
The theme of WHO for World Mental Health Day for the year 2010 is “Mental health- long term illness the need for continued and integrated care”. It is a unique opportunity to bring attention to the integration of mental health care and long term (chronic) medical illness. It should be used for awareness constituting all target audiences within and beyond the health sector. People who have a psychiatric disorder are more likely to have physical problems and are now more likely to access general hospitals to meet their health needs. A number of studies have demonstrated that the majority of general nurses have difficulty in meeting the needs of patients with mental health problems. Nurses working in general hospitals are concentrating more on physical aspects of care and psychological care is being neglected thereby the psychological problems in chronic physically ill patients remains unnoticed. Creating an awareness through in-service education programme regarding the integration of mental health nursing concepts may help the nurses understand the need, thereby they can provide a holistic care.
Objective
To assess the level of need for in-service education programme, post test level of knowledge and attitude and compare the effectiveness in-service education programme on knowledge and attitude regarding integration of mental health nursing concepts among nurses between group A and group B.
Research Approach
Quantitative Research Approach Research Design
Quasi - experimental post test only design.
Setting
Sundaram Medical Foundation, Annanagar, Chennai.
Sample
60 nurses who fulfilled the sample selection criteria Measurement and tool
Need assessment scale was used for identifying the need for in-service education programme, Structured knowledge questionnaire was used to assess the level of knowledge and a four point likert scale was used to assess the level of attitude regarding integration of mental health nursing concepts among nurses.
Both descriptive and inferential statistics were used for data analysis.
RESULTS
1. At the level of need in group A, 12(40%) of nurses had moderate level of need and 18(60%) of nurses had high level of need. Whereas in group B, 9(30%) of nurses had moderate level of need and 21(70%) had high level of need.
2. There is no significant difference in the level of need for in-service education programme between group A and group B.
3. At the post test level in group A, 19(63.33%) of nurses had adequate knowledge and 11(36.67%) of nurses had moderately adequate knowledge. Whereas in group B, 16(53.33%) of nurses had inadequate knowledge and 14(46.67%) had moderately adequate knowledge.
4. At the post test level in group A, 21(70%) of nurses had favourable attitude and 9(30%) of nurses had moderately favourable attitude. Whereas in group B, 13(43.33%) had unfavourable attitude and 17(56.67%) of nurses had moderately favourable attitude.
6. There is no significant association of post test level of knowledge and attitude with selected demographic variables like age in years, gender, religion, marital status, education, designation and total years of experience of nurses in group A and group B.
DISCUSSION Key conclusion
In group A, majority 19(63.33%) of nurses had adequate knowledge and 21(70%) of nurses had favourable attitude in the post test. This shows that the in- service education programme is relevant to enhance knowledge and attitude regarding integration of mental health nursing concepts among nurses.
Implication
The important role of nursing in addressing the mental health needs of patients across all health care settings is clearly crucial to its holistic philosophy.
The education of both current and future nurses must be viewed as an important step to rectifying the current problem.
CHAPTER – I
INTRODUCTION
BACKGROUND OF THE STUDY
Mental health is an essential part of every person's health and well-being.
Every individual, family and community should receive mental health services through early identification, treatment, and long-term support for mental illness regardless of how they enter the healthcare system.
The theme of WHO for World Mental Health Day (2010)60 is “Mental health- long term illness the need for continued and integrated care”. It is a unique opportunity to bring attention to the integration of mental health care and long term (chronic) medical illness. It should be used for awareness constituting all target audiences within and beyond the health sector.
Nurses play an essential role in rendering quality health care services which includes multidimensional (physical, psychosocial, cultural, environmental, spiritual) focus on health. This multidimensional focus can be enhanced through integration of mental health nursing concepts.
The nursing profession espouses holism as its philosophy of care. This philosophy embraces the essential interaction between the biological, psychological and social aspects of each individual. The integration of mental health services within the general health care system has increased the level of contact nurses have with people experiencing mental health problems, yet the research evidence suggests they are not confident or competent in meeting the associated needs.
Nurses constitute the largest professional health care group, comprising 45%
of full time public hospital staff and 60% of private hospital staff (Australian Bureau of Statistics 2001)1. The fundamental role of nursing in relation to health
led to the development of the concept of holism as the central philosophy for nursing. Holistic nursing care dates back to Florence Nightingale who identified the importance of the psychological and spiritual aspects of the individual when caring for their physical needs (Dossey 1998)12. The provision of holistic nursing care therefore depends on the willingness and ability to address all aspects of the person within the health care system, in order to achieve the best possible health outcome.
The mental health needs of patients must therefore be seen as crucial to the provision of high quality nursing care.
The integration of mental health care into primary health care has become an area of priority both locally and internationally. This process, known as
‘integration’ is now completed in the state of Victoria, Australia, in response to the launch of the Mental Health Policy (Australian Health Ministers 1992)2. Integration is also characterized by a fundamental shift of psychiatric services from psychiatric institutions to general health settings. Integration was intended to increase consumers’ access to a quality, comprehensive health care service and to reduce the stigmatisation of and discrimination against people experiencing a mental illness (Whiteford 1998)13.
As a direct result of integration, nurses now have more frequent contact with people experiencing mental health problems (Sharrock and Happell 2000)14. However, nurses tend not to have a comprehensive understanding of the problems and needs of people experiencing mental health problems (Bailey 1998)20. A study of emergency nurses suggests they were not clear whether their role should include care for patients with mental health problems. Consequently, nurses have come to avoid patients experiencing mental health problems because of feelings of fear and powerlessness and the acknowledgement that attending to these patients is more time consuming (Gillette et al 1996)4.
Nurses in general hospitals tend to place a higher priority on physical care than on psychosocial care (McVicar 1990)7. It has been claimed ‘basic human
skills are seriously lacking in the nursing workforce today, at least in many acute settings’ (Armstrong 2000)22. This is largely attributed to insufficient psychiatric and mental health content in undergraduate courses to prepare nurses for mental health care (Wynaden et al 2000)27.
The prevalence of mental illness is found to be higher in hospital and other health care settings than in the general population, signifying the already substantial discrepancy between what mental health care is needed and the availability of services. Australian researchers have highlighted a great need for better mental health care services across local health care settings, including general hospitals, parentcraft hospitals, nursing homes for children and adolescents (Snowdon 2001)16.
The National Survey of Mental Health and Wellbeing of Adults(1997)9 estimated that at some time during a year 1,300,000 adults over 18 years of age have an anxiety disorder, 1,042,000 a substance abuse disorder and 779,000 an affective disorder. It is important to note that 62% of those with a mental disorder do not access mental health services. Therefore, general health care settings provide an opportunity for detection and intervention for clients with a mental illness, who would not otherwise receive treatment.
It was hoped that by reducing the isolation of psychiatric services, clients would have increased access to general health care; stigmatisation and neglect would be reduced (Australian Health Ministers 1992)2. The effectiveness of comprehensive nursing curricula in the preparation of nurses to care for clients with mental illness has been questioned in Australia (Nurse Recruitment and Retention Committee 2001)63. Further to this, significant inconsistencies in the amount of time allocated to the theory and practice of mental health nursing in undergraduate programs within many universities have been identified (Happell 1998)14.
In the presence of a mainstreamed health care system all nurses need to be adequately educated and equipped with expertise to care for people with mental health problems. This is particularly relevant for medical and surgical nurses because it has been estimated that between 30% and 50% of general hospital patients have a psychiatric co-morbidity (Clarke et al 1991)21. Physical illness is known to increase the risk of psychiatric disorder. In addition, people who have a psychiatric disorder are more likely to have physical problems and are now more likely to access general hospitals to meet their health needs (Lawrence et al 2001)6.
Nursing practice is undergoing rapid change, with mental health care issues emerging as a crucial challenge for nursing education (Koch 1999)61.To create greater synchronicity between mental and physical health care is a general goal in the global effort to provide a more responsive health care system for people experiencing a mental illness (World Health Organisation 2001)64.
The important role of nursing in addressing the mental health needs of patients across all health care settings is clearly crucial to its holistic philosophy.
Indeed, if the nursing profession is to uphold this philosophy, the meeting of mental health care needs must be embraced enthusiastically.
NEED FOR THE STUDY
Nurses play a key role in caring for the individuals in sickness and in rehabilitating them after an episode of illness. A number of studies have demonstrated that the majority of general nurses have difficulty in meeting the needs of patients with mental health problems.
American data suggest that consultation rates are less than one tenth of reported prevalence rates of psychiatric morbidity in hospitals. European data also suggests that consultation liaison psychiatry service delivery falls significantly short of reported rates of psychiatric comorbidity (Huyse et al 2001)26. These
findings indicate that consultation liaison nursing alone is insufficient. Improving psychological and psychiatric care for patients on a large scale will require increased training in mental health education as part of comprehensive nursing education (Prebble 2001)15. These sentiments reflect recommendations of the World Health Organisation (2001)64 that general health personnel be trained in mental health care skills, with mental health content included in the training curricula, as well as refresher courses.
It has been acknowledged in North America that critical care unit nurses do not possess the skills and expertise to make diagnoses of anxiety, depression and delirium (Rincon et al 2001)17. Overall, it appears that for a variety of reasons, mental illness is not recognised or identified. This may be partly overcome through the application of brief screening instruments by nursing staff during patient admission (Booth et al 1998)23. Even if it is recognised that a patient has a mental illness, there is no evidence that this recognition translates to acknowledgement of a greater need for care than patients without a mental health problem (Armstrong 2000)22. This may be partly due to a lack of understanding of the extent to which mental illness contributes to precipitating, aggravating and prolonging physical disability and illness.
Increased skills in attending to the mental health needs of patients would also relieve strain on the nurses themselves, including the stress of dealing with challenging behaviour such as non-adherence to prescribed medication and lack of confidence (due to lack of training). Mental health care skills were noted to diminish distress for nurses caring for patients with dementia following an attitude change intervention (Hallberg and Norberg 1993)24.
A number of studies found that general nurses perceived themselves as lacking knowledge, skills and confidence in the assessment and management of mental health problems (Sharrock and Happell 2002)14.
Bailey (1998)20 identified feelings of fear and inadequacy and a lack of understanding among critical care nurses caring for patients post self-harm. It reveals nurses have been found to describe reduced work satisfaction; to question their role; and to give priority to physical needs and task completion in caring for patients with mental health problems.
Some evidence suggests that nurses find it particularly difficult when patient behaviour is perceived as difficult, threatening or disruptive (Heslop et al 2002)10. Compounding these difficulties is a lack of resources, expert assistance and workplace policy in relation to people with mental health problems. In addition, staff attitude is an important factor when considering the delivery of mental health nursing to patients and both negative and positive attitudes have been reported among nurses (Rogers and Kashima 1998)25.
The investigator had also personally witnessed while working as a staff nurse in the selected setting was not able to focus on the psychosocial aspect of care. The nurses were concentrating more on physical aspects of care and psychological care is being neglected thereby the psychological problems in chronic physically ill patients remains unnoticed which further aggravates the physical problems. So the investigator felt that creating an awareness through in- service education programme regarding the integration of mental health nursing concepts may help the nurses understand the need, thereby they can provide a holistic care.
STATEMENT OF THE PROBLEM
A quasi - experimental study to assess the effectiveness of in-service education programme on knowledge and attitude regarding integration of mental health nursing concepts among nurses at selected setting, Chennai.
OBJECTIVES OF THE STUDY
1. To assess the level of need for in-service education programme regarding integration of mental health nursing concepts among nurses in group A and group B.
2. To compare the level of need for in-service education programme regarding integration of mental health nursing concepts among nurses between group A and group B.
3. To assess the post test level of knowledge and attitude regarding integration of mental health nursing concepts among nurses in group A and group B.
4. To compare the post test level of knowledge and attitude regarding integration of mental health nursing concepts among nurses between group A and group B.
5. To correlate the post test level of knowledge and attitude regarding integration of mental health nursing concepts among nurses in group A and group B.
6. To associate the post test level of knowledge and attitude regarding integration of mental health nursing concepts among nurses with their selected demographic variables in group A and group B.
OPERATIONAL DEFINITION Effectiveness
Refers to outcome of the in-service education programme on level of knowledge and attitude regarding integration of mental health nursing concepts among nurses measured using structured knowledge and attitude questionnaire.
In-service Education Programme
Refers to a package of instruction given by the investigator to a group of nurses through lecture cum discussion, intended to enhance the knowledge and attitude of the nurses regarding integration of mental health nursing concepts.
Knowledge
Refers to the state of knowing of facts by the nurses to answer questions regarding integration of mental health nursing concepts.
Attitude
Refers to an expressed idea of the nurses to answer questions regarding integration of mental health nursing concepts.
Integration of mental health nursing concepts
Refers to the incorporation of mental health nursing care which is to be more focused along with General health nursing care where the nurses’ working in General health care setting are able to identify the psychosocial need of the client for mental health promotion, nursing intervention and rehabilitation for the chronically ill clients.
Nurses
Refers to all nurses working in General health care setup who are qualified with Diploma in General Nursing and Midwifery or B.Sc.Nursing or Post Basic.B.Sc.Nursing in the age group of 21 – 35 years of both gender.
ASSUMPTIONS
1. Nurses may have some knowledge and attitude regarding integration of mental health nursing concepts.
2. In-service education programme may enhance adequate knowledge and attitude regarding integration of mental health nursing concepts among nurses.
NULL HYPOTHESES
NH1 – There is no significant difference in the level of need for in – service education programme regarding integration of mental health nursing concepts among nurses between group A and group B at p<0.001.
NH2 – There is no significant difference in the post test level of knowledge and attitude regarding integration of mental health nursing concepts among nurses between group A and group B at p<0.001.
NH3 – There is no significant relationship in post test level of knowledge score with attitude score regarding integration of mental health nursing concepts among nurses between group A and group B at p<0.001.
NH4 – There is no significant association of post test level of knowledge and attitude score regarding integration of mental health nursing concepts among nurses with their selected demographic variables between group A and group B at p<0.001.
DELIMITATION
The study was limited to a period of 4 weeks.
CONCEPTUAL FRAMEWORK
Kerlinger views theory as a set of interrelated concepts that gives systematic view of a phenomenon that is explanatory and predictive in nature.
The present study was aimed at helping the nurses working in Sundaram Medical Foundation to improve the knowledge and attitude regarding integration of mental health nursing concepts. Hence the study was based on Wiedenbach’s Prescriptive Theory.
According to Wiedenbach, the practice of nursing comprises a wide variety of services, each directed towards the attainment of one of its three components.
STEP – I: IDENTIFYING THE NEED FOR HELP There are two components.
(a) General Information: This comprises of collection of demographic variables and conducting a need assessment for in-service education programme.
(b) The central purpose: Central purpose refers to what the investigator wanted to accomplish. Here the central purpose was to improve the nurses’
knowledge and attitude regarding integration of mental health nursing concepts.
STEP – II: MINISTERING THE NEEDED HELP (GROUP A) Action/Prescription:
It refers to the plan of care, the nature of action that will fulfill the central purpose. Here, the prescription was the In–service education programme needed to enhance the nurses’ knowledge and attitude regarding integration of mental health nursing concepts by powerpoint presentation through lecture cum discussion method.
Reality:
The realities are the immediate situation that influences the fulfillment of the central purposes. Nurse should consider the realities of the situation in which she has to provide nursing care. Wiedenbach defines the five realities.
The Agent: Is the person who is providing care of her delegates characterized by personal attribute, problems commitment and competence in nursing. Here it was the nurse investigator, who directed all action/prescription towards the central purpose.
The Recipient: Is the patient who is characterized by the personal attributes, problems, capacities, aspirations and ability to cope with the concern or problems being experienced. Here it was the nurses working in Sundaram Medical Foundation, who received the nurse investigator’s action/prescription.
The Goal: Is the defined outcome the nurse wishes to achieve. Here it was to improve the nurses’ knowledge and attitude regarding integration of mental health nursing concepts.
The Means: Comprises the activities and devices through which the agent attains the goal. The means include skills, techniques, procedures and
devices that may be used to facilitate nursing practice. Here it was the In–
service education programme needed to enhance the nurses’ knowledge and attitude regarding integration of mental health nursing concepts.
The Framework: Refers to the facilities in which nursing is practiced. Here it was the Sundaram Medical Foundation, located in Annanagar which is a non-profit hospital consisting of 160 beds.
GROUP B: Followed the hospital routine which included CNE’s conducted every Tuesdays and Wednesdays (twice a week) where the nurses were taught on physical aspects of care for patients admitted in General Hospital setting.
STEP – III: VALIDATING THAT THE NEEDED HELP WAS MET. It is validation that the needed help was delivered in achieving the central purpose. The step involves the post assessment done after ministering the help and the analysis to infer the outcome. Here it was the comparison of level of knowledge and attitude score between group A and group B.
OUTLINE OF THE STUDY REPORT
CHAPTER I – Includes Introduction, Background, Need for the study.
CHAPTER II - Review of literature.
CHAPTER III - Research Methodology.
CHAPTER IV - Data Analysis and Interpretation.
CHAPTER V - Discussion.
CHAPTER VI - Summary, Conclusion, Implication, Recommendation and limitation.
CHAPTER – II
REVIEW OF LITERATURE
Review of literature is a systematic search of a published work to gain information about a research topic. Through the literature review, researcher generates a picture of what is known about a particular situation and the knowledge gap that exists between the problem statement and the research subject problems and lays a foundation for the research plan.
The literature review was based on an extensive survey of journals, books, and international nursing indicates. A review of research and non research literature relevant to the study are categorized under the following headings:
Section A: Studies related to prevalence of psychological problems associated with physical illness in general health care setting:
Section B: Studies related to psychological factors associated with the development of physical illness.
Section C: Studies related to nurses knowledge regarding identification of psychological symptoms in patients with medical condition in general health care setting.
Section A: Studies related to prevalence of psychological problems associated with physical illness in general health care setting
Aikens JE (2011)30 conducted a descriptive study on prevalence of somatic indicators of distress in diabetes patients using Symptom Checklist 90-R (SLC-90- R). Of the fifteen SCL-90-R items rated by endocrinologists as most likely to be diabetes-related, nine were endorsed more frequently by diabetes patients than by non patients: faintness/dizziness (endorsed by 36% of diabetics), reduced libido (endorsed by 41%), an energia (68%), memory problems (66%), trembling (18%), numbness (55%), weakness (39%), overeating (59%), and somatic concerns (41%).
Anergia and faintness/dizziness were endorsed more frequently by psychiatric patients than diabetes patients, whereas numbness was endorsed more often by diabetes patients.
Kurd SK et.al (2010)31 conducted a population – based cohort study to determine the incidence of depression, anxiety, and suicidality in patients with psoriasis compared with the general population using data collected as part of patient's electronic medical record from 1987 to 2002. Analyses included 146 042 patients with mild psoriasis, 3956 patients with severe psoriasis, and 766 950 patients without psoriasis. Five controls without psoriasis were selected from the same practices and similar cohort entry dates as patients with psoriasis. It was estimated that 10 400 diagnoses of depression, 7100 diagnoses of anxiety, and 350 diagnoses of suicidality are attributable to psoriasis annually.
Mimiaga MJ et.al (2010)32 conducted a cross-sectional study of adult Emergency Department patients in a general hospital enrolling in a human immunodeficiency virus screening were analyzed. Of the 3,262 patients enrolled in the screening trial, 2,588 (79%) completed the survey. Among these, 1,945 (75%) completed the psychosocial assessment battery; 596 (31%) survey completers screened positive for clinically significant depressive symptoms. In a multivariable model, female sex, being unemployed, and lower annual income were associated
with increased rates of clinically significant depressive symptoms. This study identified a high frequency of undiagnosed clinically significant depressive symptoms among Emergency Department patients.
Rupesh Chaudhry et.al (2010)33 assessed the prevalence of psychiatric morbidity among hundred diabetic patients in Dayanand Hospital, Punjab using standardized (Hamilton) rating scales for depression and anxiety. About 84% of the patients had comorbid depression. Females showed a high percentage of depression and anxiety, and the severity of somatic symptoms were also higher in the females.
Chaudhry R et.al (2010)33 conducted a descriptive study on the prevalence of psychiatric morbidity among diabetic patients using standardized rating scales for depression and anxiety.100 diagnosed patients of diabetes were assessed on the Hamilton rating scale for depression and the Hamilton rating scale for anxiety, who were attending the diabetic clinic. They were assessed on socio demographic profile, duration of illness, type of treatment, and oral vs insulin, and then the data were analyzed on different domains. The prevalence of depression among diabetics ranges from 8.5% to 32.5%, while that for anxiety disorders it is up to 30%.
Females showed a high percentage of depression and anxiety, and the severity level was also higher in the females. Genital symptoms were usually reported by the males, while somatic symptoms were more prevalent in the females.
Lun-Fang et.al (2009)34 conducted a descriptive study on prevalence of mood and anxiety disorders in patients with systemic lupus erythematosus (SLE).
326 white women with SLE completed the Composite International Diagnostic Interview and the Systemic Lupus Activity Questionnaire. The binomial test was used to compare the prevalence of psychiatric diagnoses in patients with SLE with a population sample of white women. 65% of the participants received a lifetime mood or anxiety diagnosis. MDD (47%), specific phobia (24%), panic disorder (16%), obsessive-compulsive disorder (9%), and bipolar I disorder (6%) were more
common among patients with SLE than among other white women (P = 0.00009 for specific phobia; for all other values P = 0.00001). The study concluded that several mood and anxiety disorders were more common in women with SLE compared with the general population, and disease activity may contribute to this higher risk.
Danson R. Jones et.al (2008)35 conducted a descriptive study to determinethe prevalence, severity, and co-occurrence of mental illnessin 147 samples with chronic physical illness. 74% of the study sample had been given a diagnosisof at least one mental illness, and 50% had been given a diagnosis of two or more mental illness.Of the 14 mental illnesses surveyed, 31% had major depression. The study concluded that risk assessment for mental illness is essential when setting performance standards for physical illness treatment.
Atesci FC et.al (2007)36 conducted a descriptive study on psychiatric morbidity and awareness of illness among 117 Turkish cancer patients using the Structured Clinical Interview for DSM-IV, the Hospital and Anxiety Depression Scale and the General Health Questionnaire. Of these patients, 30% had a psychiatric diagnosis. Adjustment disorders comprised most of the psychiatric diagnoses. 64 (54.7%) were unaware of the diagnosis of cancer whereas (67.9%) were aware of the cancer diagnosis stated that they had guessed their illness from the treatment process or drug adverse effects. Psychiatric morbidity was significantly higher in the patients who knew that they had a cancer diagnosis (P=0.03). These findings suggest that the understanding of the diagnosis indirectly may be stressful to the patient because it arouses suspicion about the cancer and treatment, and consequently can lead to psychiatric disturbance.
Fenton WS et.al (2007)37 provides a review about recent findings on co- morbidity of cardiovascular disease and diabetes in mood disorders. It was found that depressed patients with heart disease have poorer medical outcomes including increased risk of reinfarction and all-cause mortality. Patients with diabetes and
depression have poorer glycemic control, more diabetes symptoms, and greater all- cause mortality. Depression is associated with both biological (hypothalamic- pituitary-adrenal axis dysregulation) and psychosocial processes (adherence, poorer diet, and exercise) that may mediate adverse medical outcomes.
Qin X, et al. (2006)38 conducted a study on the prevalence rates of depressive disorders in internal medicine outpatient departments of 23 general hospitals in China. The results show that 21.5% had depression. Only 4% of the depressed patients were identified by the treating clinician and only 3% were provided with antidepressant medication.
M. Pothen et al. (2006)39 assessed the prevalence of psychiatric morbidity in General hospital medical clinic in Vellore using Clinical interview. 27% of the patients had common mental disorders like organic psychosis, schizophrenia, affective disorders, mental retardation, epilepsy, neurotic disorders and substance abuse
Section B: Studies related to psychological factors associated with the development of physical illness
Gao W et.al (2011)40 conducted a study to determine the factor structure of the 12-item General Health Questionnaire across the cancer trajectory represented from cancer outpatient (n=200), general community (n=364) and palliative care (n=150) settings using exploratory factor analysis. The results of the study were the best scoring method was the chronic GHQ for the cancer outpatient, modified Likert for the general community and standard GHQ for the palliative care. The GHQ-12 displayed a correlated two-factor structure ('social dysfunction' and 'distress'). The study concluded that the GHQ-12 was more problematic (less clear factor structure and evidence of item bias) for newly diagnosed patients, less problematic for patients approaching end-of-life and satisfactory for patients between those times.
Salvatore Rinaldi et.al (2011)41 conducted a study to investigate the effects of a radio electric asymmetric treatment on psycho-physiological disorders (PPD).
Psychological stress and PPD were measured for a group of 888 subjects using the Psychological Stress Measure (PSM) test, a self-administered questionnaire. At the end-point the number of subjects reporting symptoms of stress-related PPD on the PSM test was significantly reduced, whereas in the placebo group the difference was not significant. The study concluded that a cycle of NPPO treatment with REAC was shown to reduce subjective perceptions of stress measured by the PSM test and in particular on PPD.
Joseph A. Boscarino (2010)42 conducted a prospective study to examine early-age heart disease (HD) among a national random sample of 4328 male Vietnam veterans, who did not have HD at baseline in 1985. This study assessed PTSD in predicting HD mortality at follow-up in December 31, 2000 using Cox regression. Using two PTSD measures, it was found that among Vietnam veterans having PTSD was associated with HD mortality for D-PTSD and approached significance for K-PTSD. The study concluded that PTSD was prospectively associated with HD mortality among veterans.
Fischer CE et.al (2010)43 conducted a retrospective study to examine 85 patients on how medical co-morbidity, socioeconomic status (SES), education and depression are associated with subjective and objective memory function. The findings show that impaired objective cognitive function correlated significantly with increased medical co-morbidity and partially with education but not with SES or depression. Elevated memory complaints correlated significantly with depression and with medical co-morbidity and correlated inversely with SES and education.
Dyster-Aas et.al (2009)44 conducted a longitudinal study to assess major depression and post-traumatic stress disorder symptoms following severe burn injury in 64 patients at a 12 month follow-up. 10 patients (16%) met criteria for
major depression, 6 (9%) for PTSD, and 11 (17%) for subsyndromal PTSD. The study concluded that two-thirds of burn survivors have a higher risk of postburn psychiatric problems
J. K. Quint et.al (2009)45 conducted a prospective study to assess whether depression, as determined by the Centre for Epidemiologic Studies Depression Scale, was related to exacerbation of COPD. The associations of any increase in depressive symptoms at exacerbation were also investigated. Frequent exacerbators had a significantly higher median (interquartile range) baseline depression score than infrequent exacerbators (17.0 and 12.0 respectively). Depression increased significantly in patients from baseline to exacerbation (12.5 and 19.5 respectively).
The study concluded that there is a relationship between depression and exacerbation frequency in patients with chronic obstructive pulmonary disease.
Deirdre A. Lane et.al (2007)46 conducted a study to determine how health- related quality of life, depression, and anxiety change over the first 12 months following diagnosis of atrial fibrillation in 70 patients. These patients reported few depressive symptoms, while anxiety symptoms predominated, with a prevalence of elevated state anxiety of 38.4%, 30.9%, and 30.7% at baseline, at 6 and 12 months, respectively. The study concluded that anxiety appears to be the main affective response to diagnosis of AF in a cohort of patients without other associated comorbidities.
McCusker J et.al (2007)47 conducted a longitudinal observational study to examine whether a diagnosis of depression in 97 cognitively intact medical inpatients aged 65, is associated with the physical and mental health status of their informal caregivers after 6 months. Multivariate linear regression analyses were conducted to determine the relationship between patient depression and caregiver 6 month SF-36 physical and mental scores. Results showed that in comparison with caregivers of patients without a current diagnosis of depression, caregivers of those with major depression had a lower mental health score at follow-up, even though
their physical health was slightly better. The study concluded that a diagnosis of major depression in older medical inpatients is independently associated with poor mental health in their informal caregivers 6 months later.
Thombs BD et.al (2007)48 conducted an experimental study to evaluate whether people receiving in-patient treatment following acute myocardial infarction (AMI) had higher somatic symptom scores on the Beck Depression Inventory-II (BDI-II) than a non-medically ill control group matched on cognitive/affective scores. Somatic scores on the BDI-II were compared between 209 patients admitted to hospital following an AMI and 209 psychiatry out-patients matched on gender, age and cognitive/affective scores. The findings were somatic symptoms accounted for 44.1% of total BDI-II score for the 209 post-AMI and psychiatry out-patient groups. Post-AMI patients had somatic scores on average 1.1 points higher than the psychiatric out-patient groups (P<0.001).
Timothy D Girard et.al (2007)49 conducted a prospective cohort study to identify factors associated with PTSD symptoms in patients following critical illness requiring mechanical ventilation. 43 patients who were mechanically ventilated were prospectively followed during their ICU admission for delirium with the Confusion Assessment Method. 6 months after discharge, multiple linear regression was used to assess the association of potential risk factors. It was found that high levels of PTSD symptoms occurred in 14% of patients and these symptoms were most likely to occur in female patients and those receiving high doses of lorazepam and it was less likely to occur in older patients.
Clarke DM et.al (2006)50 conducted a qualitative study of the experience of 'depression' among 49 hospitalized medically ill patients. From the transcripts, a 'folk' taxonomy was constructed using a phenomenological framework.
Patients who were identified by screening as being depressed described unique experiences of depression, which included 'having to think about things' (a forceful intrusive thinking), 'not being able to sleep', 'having to rely on others', 'being a
burden' to others (with associated shame and guilt), feelings of 'not getting better' and 'feeling like giving up'. This experience of depression fitted well with the concept of demoralization described by Jerome Frank. Demoralization, which involves feelings of being unable to cope, helplessness, hopelessness and diminished personal esteem, characterizes much of the depression seen in hospitalized medically ill patients.
Helvik AS et.al (2006)51 conducted a study to describe the quality of life and explores health-related factors associated with domains of the QOL in 484 acutely ill and hospitalised elderly using World Health Organisation's WHOQOL- BREF. The results of the study was that the overall QOL was good in two-thirds of the elderly patients. In multiple linear regression models, lower physical QOL was significantly associated with a number of medications, impaired personal activities of daily living, impaired cognition, depression and anxiety. Lower psychological QOL was significantly associated with impaired PADL, impaired cognition, depression and anxiety. Lower social QOL was significantly associated with depression and anxiety. Lower environmental QOL was significantly associated with female gender, impaired PADL, depression and anxiety.
Russell, V. (2006)52 conducted a systematic review to investigate literature on anxiety in patients experiencing symptoms of myocardial infarction and the provision of psychological care to this group with the aim of improving practice. A literature search was undertaken to identify articles linking the nurse's role in caring patients with MI and the need for psychological care within acute medicine.
Articles were assessed for quality and bias and common themes identified. The 23 articles included in the review suggest that patients with symptoms of MI experience some level of anxiety and that they are not always offered psychological interventions to alleviate this anxiety.
Krahn LE et.al (2002)53 conducted a retrospective study on 93 patients diagnosed as factitious disorder with physical symptoms. Two raters agreed on subject eligibility on the basis of DSM-IV criteria and absence of a somatoform disorder and a plausible medical explanation. The group included 67 women (72.0%); mean age was 30.7 years (SD=8.0) for women and 40.0 years (SD=13.3) for men. Mean age at onset was 25.0 years (SD=7.4). Health care training or jobs were more common for women (65.7%) than men (11.5%). Most often, inexplicable laboratory results established the diagnosis. The study concluded that diagnosis of factitious disorder must be based on careful examination of behavior, motivation, and medical history and not on a stereotype.
Laboratory data and outside medical records help identify suspicious circumstances and inconsistencies. Confrontation does not appear to lead to patient acknowledgment and should not be considered necessary for management.
Kirsh KL et.al (2000)54 conducted an empirical study on abuse and addiction issues in medically ill patients with pain. The assessment of addiction- related outcomes is crucial to the management of chronic pain with opioid drugs in all patients. Complicating the issue is the notion of pseudoaddiction, which is an abuse of medications driven by unrelieved pain that appears on the surface to be very similar to the behavior patterns of addicts. For proper adherence to medical therapy and safety during treatment, it is necessary to address and manage substance abuse-related behaviors. The article concluded that there is a definite need for large-scale studies that address the issues of identification and treatment of aberrant behavior in medically ill patients in the effort to provide the best possible outcomes for patients with chronic pain.
Section C: Studies related to nurses knowledge regarding identification of psychological symptoms in patients with medical condition in general health care setting
Matthews EE (2011)55 conducted an empirical study on sleep disturbances and fatigue in critically ill patients. It was found that sleep disturbance and debilitating fatigue that originate during acute illness may continue months after discharge from intensive care units (ICUs). If these issues are unrecognized, lack of treatment may contribute to chronic sleep problems, impaired quality of life, and incomplete rehabilitation. A multidisciplinary approach that incorporates assessment of sleep disturbances and fatigue, environmental controls, appropriate pharmacologic management, and educational and behavioral interventions is necessary to reduce the impact of sleep disturbances and fatigue in ICU patients.
Nurses are well positioned to identify issues in their own units that prevent effective patient sleep.
Svediene Let.al (2009)56 conducted a quantitative study on competence of 128 general practice nurses caring for patients with mental health problems in the somatic departments. About 45.0% of general practice nurses had knowledge how to care for the patients with mental health problems, from 1.6 to 21.9% did not have knowledge, and the rest reported having only moderate knowledge (28.1-64.1%).
These findings provided a statistically significant link between the duration of employment and education (r from 0.292 to 0.76; P from <0.05 to <0.01). This may be associated with insufficient professional skills, conflict situations with the patients, and the lack of acknowledgment of the principles of nursing.
Julie Sharrock (2006)57 conducted a study through grounded theory approach with nurses from general health care settings that provide medical- surgical care and treatment to explore and describe the subjective experience of nurses in providing care for patients experiencing mental health problems. The findings indicated the nurses were striving for competence in the provision of mental health care. This study supports the notion that general nurses lack
confidence when caring for patients with mental health problems in medical and surgical settings. It also highlights a discrepancy between the holistic framework encouraged at undergraduate level and what is experienced in practice.
AM Price (2004)58 conducted a qualitative study on Intensive care nurses' experiences of assessing and dealing with patients' psychological needs.12 nurses, who were working in ICU, were interviewed using a semi-structured technique. Six categories were developed about issues in psychological care. Implications for practice included the important role of the family, need for improved communication and improved staff awareness of issues.
K.Keshavan et.al (2001)59 assessed the psychiatric knowledge and skills of forty six nurses working in a general hospital in Bangalore, India. They were evaluated objectively using Multiple Choice Questionnaire (MCQ) and case vignettes. The results revealed that these general nurses had less than satisfactory mental health knowledge and skills. The findings highlighted the need for systematic in-service training for nursing staff in mental health problems.
CHAPTER – III
RESEARCH METHODOLOGY
This chapter deals with the methodology used to assess the effectiveness of in-service education programme on knowledge and attitude regarding integration of mental health nursing concepts among nurses in selected setting.
This phase of the study deals with research approach, research design, variables, setting of the study, population, sample, criteria for sample selection, sample size, sampling technique, development and description of the tool, content validity, pilot study, reliability, data collection procedure and plan for data analysis.
RESEARCH APPROACH
In view of the nature of the problem and to accomplish the objectives of the study Quantitative research approach was selected.
RESEARCH DESIGN
The research design used for this study was quasi - experimental post test only design. Based on Polit and Hungler (2011), framework for the study was done as:
INTERVENTION POST TEST
GROUP A
(Need assessment for in-service education programme regarding
integration of mental health nursing concepts among nurses)
In-service education programme regarding
integration of mental health nursing concepts
among nurses.
Post test level of knowledge and attitude regarding integration of mental health
nursing concepts among nurses.
GROUP B
(Need assessment for in-service education programme regarding
integration of mental health nursing concepts among nurses)
_
Post test level of knowledge and attitude regarding integration of mental health
nursing concepts among nurses.
VARIABLES
Independent Variable
The independent variable in this study was the in-service education programme regarding integration of mental health nursing concepts.
Dependent Variable
The dependent variables in this study were the knowledge and attitude of nurses regarding integration of mental health nursing concepts.
Extraneous Variable
The extraneous variables in this study were age, gender, education, qualification, years of experience, area of work.
SETTING OF THE STUDY
The study was conducted in Sundaram Medical Foundation, Annanagar, Chennai, which is a non profit hospital consisting of 160 beds. The setting was chosen on the feasibility in terms of availability of samples and familiarity of the investigator with the setting.
POPULATION
The target population for the study included all nurses working in the general health care setting and the accessible population was 105 nurses who were working in Sundaram Medical Foundation, Annanagar, Chennai.
SAMPLE
A total of 60 nurses who fulfilled the sample selection criteria was selected as sample for the study.
CRITERIA FOR SAMPLE SELECTION
The following criteria were adopted for the selection of respondents.
Inclusion Criteria
1. Nurses who were willing to participate in the study.
2. Nurses who were qualified with Diploma in General Nursing and Midwifery or B.Sc.Nursing degree or Post Basic.B.Sc.Nursing.
Exclusion Criteria
1. Nurses who had undergone special training in mental health nursing.
2. Nurses who had less than one year of experience.
SAMPLE SIZE
The sample size consisted of 60 nurses out of which 30 were in group A and 30 were in group B.
SAMPLING TECHNIQUE
The samples were selected using non – probability convenient sampling.
The investigator selected 30 nurses in the group A and 30 nurses in the group B who were working in general medical ward, surgical ward, ICU/IMCU, emergency room, stroke ward and dialysis based on the accessibility of nurses working during the study period in selected hospital.
DEVELOPMENT AND DESCRIPTION OF THE TOOL
After an extensive review of literature, discussion with the experts and with the investigator’s personal and professional experience, a self – administered questionnaire was developed to assess knowledge and four point likert scale to assess attitude regarding integration of mental health nursing concepts among nurses.
The tool for data collection consisted of 5 sections:
SECTION A:
This section consisted of Structured profile which was used to elicit demographic data of nurses. This included age in years, gender, religion, marital status, education, designation, total years of experience and area of work.
SECTION B:
This section consisted of Need Assessment scale which was used to identify the need for conducting an in-service education programme for nurses regarding integration of mental health nursing concepts.12 dichotomous questions were formulated.
QUESTION
NUMBER RATING ( IN MARKS)
YES NO
POSITIVE WORDED 1,2,4,5,6,7,8,9,10,12 1 0
NEGATIVE WORDED 3,11 0 1
Scoring key:
SECTION C:
This section consisted of Self administered questionnaire. 24 questions were formulated under sub-headings to assess knowledge regarding integration of mental health nursing concepts among nurses. The items are as follows
S.No Items No. of questions
1 - 6 Assessment 6
7 - 11 Diagnosis/outcome identification 5
12 - 18 Planning 7
19 - 22 Implementation 4
23 - 24 Evaluation 2
SCORE PERCENTAGE LEVEL OF NEED
10 – 12 >75 Low level of need
7 – 9 50 – 75 Moderate level of need
0 – 6 <50 High level of need
Scoring Key:
The items were rated as ‘1’ for correct answer and ‘0’ for wrong answer.
Total item score: 24. Maximum score was 24 and minimum score was 0.
SCORE PERCENTAGE LEVEL OF KNOWLEDGE
19 – 24 >75 Adequate knowledge
13 – 18 50 – 75 Moderately adequate knowledge
0 – 12 <50 Inadequate knowledge
SECTION D:
This section consisted of four point Likert scale. 15 statements were formulated to assess the attitude regarding integration of mental health nursing concepts among nurses.
QUESTION NUMBER
RATING ( IN MARKS) STRONGLY
AGREE AGREE DISAGREE STRONGLY DISAGREE POSITIVE
STATEMENTS
3,4,6,8,9,10,11,12
4 3 2 1 NEGATIVE
STATEMENTS
1,2,5,7,13,14,15
1 2 3 4
Scoring Key:
SCORE PERCENTAGE LEVEL OF ATTITUDE
46 – 60 >75 Favourable attitude
31 – 45 50 – 75 Moderately favourable attitude
15 – 30 <50 Unfavourable attitude
SECTION E:
This section consisted of the Intervention tool which was the In-service education programme regarding integration of mental health nursing concepts. A powerpoint presentation through lecture cum discussion method.
It includes the following description
¾ Introduction to mental health component
¾ Need for integration of mental health nursing concepts
¾ Application of nursing process in the integration of mental health nursing concepts
• Assessment
The assessment includes
9 Psychological responses to physical illness
9 Factors which may affect response to physical illness 9 Assessment of non-verbal behavior
9 Brief psychological assessment
• Diagnosis / Outcome Identification
This includes nursing diagnoses common to the general category of psychological factors affecting medical condition.
• Planning
9 Providing information
9 Language difficulties and disabilities 9 Listening to patients
9 Active listening skills
9 Involving patients in decision-making
9 Managing uncertainty and breaking bad news 9 Stressful medical procedures
9 Developing communication skills 9 Stress and communication
9 Handling anger and conflict
• Implementation
9 This includes example of care plan for clients with psycho – physiological disorder.
9 Client / or Family Education
Discussion on psychological implications of exacerbation of physical symptoms
• Evaluation
This includes discussion on evaluation of the nursing actions for the client with a psycho physiological disorder
CONTENT VALIDITY
The content validity of the data collection tool and intervention package was ascertained from the experts in the following field of expertise.
Nursing experts (educational setup) – 4 Psychiatrist – 1
Additions and modifications that were suggested by the experts were incorporated in the tool. All the experts have given their consensus and then the tool was finalized before main study data collection.
ETHICAL CONSIDERATION
Ethics is a system of moral values that is concerned with the degree to which the research procedures adhere to the professional, legal and social obligations to the study participants. Polit and Hungler (2011)24
1. BENEFICIENCE
The investigator followed the fundamental ethical principle of beneficience ( doing good) by adhering to
a) The right to freedom from harm and discomfort
The study will be beneficial for the participants as it enhances their knowledge about central line care protocol and improves their practice while taking care of clients with central line.
b) The right to protection from exploitation
The investigator explained the procedure and nature of the study to the participants and ensured that none of the participants in both group A and group B would be exploited or denied fair treatment.
2. RESPECT FOR HUMAN DIGNITY
The investigator followed the second ethical principle of respect for human dignity. It includes the right to self determination and the right to self disclosure.
a) The Right to Self-determination.
The investigator gave full freedom to the participants to decide voluntarily whether to participate in the study or to withdraw from the study and the right to ask questions.
b) The Right to Full Disclosure.
The researcher has fully described the nature of the study, the person’s right to refuse participation and the researcher’s responsibilities based on which both oral and written informed consent was obtained from the participants.
3. JUSTICE
The researcher adhered to the third ethical principle of justice, it includes participant’s right to fair treatment and right to privacy.
a) Right to Fair Treatment
The researcher selected the study participants based on the research requirements. The investigator followed hospital routine for group B.
b) Right to Privacy.
The researcher maintained the participant’s privacy throughout the study.
4. CONFIDENTIALITY:
The researcher maintained confidentiality of the data provided by the study participants.
