RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

BANGALORE, KARNATAKA

PROFORMA SYNOPSIS FOR REGISTRATION SUBJECT FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND
ADDRESS / Ms. K. PADMAVATHI DEVI
I YEAR M.Sc NURSING
UNIVERSAL COLLEGE OF NURSING
BANNERGHATTA MAIN ROAD
GOTTIGERE
BANGALORE- 560083
2 / NAME OF THE INSTITUTION / UNIVERSAL COLLEGE OF NURSING
BANNERGHATTA MAIN ROAD
GOTTIGERE
BANGALORE- 560083
3 / COURSE OF STUDY AND SUBJECT / DEGREE OF MASTER OF SCIENCE IN NURSING , PSYCHIATRIC NURSING.
4 / DATE OF ADMISSION TO THE COURSE / 01-06-2009
5 / TITLE OF THE TOPIC / “A COMPARATIVE STUDY OF THE ATTITUDE TOWARDS MENTAL ILLINESS OF II YEAR B.Sc NURSING STUDENTS WITH THAT OF IV YEAR NURSING STUDENTS IN SELECTED COLLEGES OF NURSING, BANGALORE.”

6.0 BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

The standards of mental health are less clear than those of mental illness. Mental health is often spoken of a state well being associated with happiness, contentment, satisfaction, achievement, optimism or hope.

The concept of mental health or illness has a problematic definition because it is largely subjective. It can only achieve a near uniformity of meaning in the mental health or well being is almost impossible to attain. The sufferer of mental illness are part of the society but are viewed differently by the society.

Therefore, societal reaction to the mentally sick varies from society to society, as the culture of a people is also a model for human behaviour. Mental illness is a disorder of one or more of the functions of the mind such as emotions, perception memory or thoughts, which causes suffering to the person and embarrassment to the family and society 4.

There are a varied number of mental illnesses but the most common and broader classification is phychoses, neuroses and mental retardation. Mental illness could be sparred by psysiological malfunctioning and heredity. These are referred to as functional and organic psychoses respectively. Allport (1961) posited that an attitude is mental and neural state of readiness organized through experience, exerting a dynamic influence upon the individual response to all objects or to situations with which it is related 5.

Similarly (E Whrudjakpor 1995, Mohammed and Mohammed 2008) defines an attitude as a “learned orientation which provides a tendency to respond favourably or unfavourably to the object or situation”. However strong these attitude definitions are it way (Zimbardo and Ebbesen 1969) that put it in proper structure when they defined it as a “pre-dispositions, toward any person, ideas or objects. It contains cognitive, affective and behavioural components. Thus, individually disposition becomes an attitude if it contains in some parts, aspects of knowing and acting.

Zimbarde and Ebbesen (1969) further assert that, affective component of our attitude consists of a person’s evaluation of liking and emotional response to some objects or person. The cognitive component refers to the way the object or person is perceived. It is infact the mental picture formed in the individual’s brain. This includes the person’s thoughts, beliefs and knowledge about the object. The behaviour component involves the person’s avert acts directed towards another person or group of persons or objects 4.

Attribution theory of pastulated by (Heider 1958) states the rules people use to refer the causes of observed behaviour. He divides this process into two : dispositional and situational attribution process. The dispositional attribution is the process where a person’s actions is attributed to internal disposition (attitudes, traits, motives) while situational attribution is attributing a person’s actions to factors in the environment such as witchcraft, poverty, beliefs and so forth.

6.1 NEED FOR STUDY

Attribution of mentally ill with dangerousness and violence is very often due the portrayal of mentally ill people as violent and dangerous on the media (Lyons & Mc Loughlin, 2001). It was argued by Hyler, Gabbard and Schneider (1991) that presentation of mentally ill people as dangerous and violent have been so frequent in films, television, novels and comics that people accept them without a second thought.

The most devastating and frightening experience the mentally ill has to undergo is isolation and loneliness. People tend to seclude the mentally ill from others, the family who once loved and cared for the person suddenly separates the person from the rest of the family and neglects the needs of the mentally ill person. Once institutionalized, many families refuse to take back their mentally ill family members even after recovery from the illness, forcing these already miserable people to totally lose trust in others and their condition takes a turn back into its worse. Apart from the above, mentally ill are also harassed and tortured in ways like chaining them down so that they cannot move and inflicting other bodily pain and harm (Rotella, Gold & Adriani, 2002).

The stereotypical labeling of the mentally ill becomes so permanent that the person is stigmatized with the stereotypical names even after recovering form the illness. People fail to understand their capabilities because of an unfortunate illness they encountered and are refused jobs for which they are qualified. This makes it difficult for the ex-mental patients to pull themselves up and gain a level of independence in the community (Huxley, 1993).

Psychiatric stigmatization had led to the formation of widespread negative attitude towards mentally ill among public. According to the World Health Report (2001), stigma and discrimination are the main obstacles facing the mentally ill today and it is the shame and fear of this discrimination that prevents the mentally ill from seeking help and care for their disorders (World Health Organization, 2001). Corrigan, Edwards, Green, Diwan and Penn (2001) states that stigma is known to create a hidden burden among the mentally ill ultimately resulting in reluctance to seek help and delay in rehabilitation 6.

Attitudes of health personnel towards mentally ill patients influences the care they receive or the decisions made for them. Nurses are members of the health team will be safeguarding the patients 24 hours during the hospitalization. Mental health is the important aspect of the total health and well being.

It is very much needed for nurses to have positive attitudes towards mentally ill in order to contribute for their health promotion and speedy recovery.

In a word settings nurses are the influencing persons for nursing students in all aspects of practical training. They all play a major role in shaping the students attitudes towards mental patient like wise any other patients.

Nursing students are future health manpower. They will be the part of societal development. In order to fulfill their role they need to be trained in such a way to develop positive attitudes towards needy people. They have to understand that mental illness are like physical illnesses which need to be tackled skillfully and scientifically.

Unfortunately the universality of harmful beliefs and subsequent negative attitudes towards mentally ill is not in doubt even among nursing students. On the other hand mentally ill are increasing in India.

Statistics ..in.. Indian Journal of Community Medicine - Epidemiological study of prevalence of mental disorders in India. Prevalence rates for all mental disorders was observed to be 65.4 / 1000 population. Prevalence rate for schizophrenia, affective disorders (depression) anxiety neurosis, hysteria and mental retardation were 2.3, 31.2, 18.5, 4.1 and 4.2/1000 population respectively. The urban morbidity rate was 2/1000 higher than the rural rate 11.

Prevalence of dementia in a rural setting, a report from India. A study was conducted in a community located on the outskirts of Madras city in South India. By using GMS (Genetic Mental Schedule) 750 elderly persons were interviewed the prevalence of dementia was 3.5%, the % increasing with age. There rural prevalence estimated were higher than in urban settings (and male/female differences were negligible 13.

In India it has been observed that health manpower and population is not up to the level of acceptable ratios. Hence students are given more burdened to face the responsibility of rendering health care. The investigator has observed that in some situations students are given complete responsibility of the assigned case. In such incidents students attitudes also very important for the patient recovery. Many studies proved that many students are having unfavourable attitudes towards mentally ill.

An Australian study conducted 2008, concluded that nursing students typically hold unfavourable attitudes towards mental health nursing career.

A study was conducted in Nigeria (2009) on knowledge, beliefs and attitudes of health care providers towards the mentally ill. The result of the study showed a positive relationship between mental illness and socio-cultural practices. Therefore if cultural beliefs surrounding psychiatry are unchanged, the attitudes of people towards sufferers will remain for from being favourable as the present study reports 4.

A study was conducted in Gwalior on attitudes of ward attendants towards mental illness. The outcomes of the study showed that psychiatric attendants had more positive attitudes than general attendants towards psychiatric illness. Socio-demographic variably like older age, higher education and longer duration of contact with the psychiatrically ill predicted more favourable attitudes 1.

A study was conducted an Attitudes of Jordanian nursing students towards mental illness, the effect of teaching and contact on attitudes change the result showed that more positive attitudes towards mental illness in four scales attitudes about mental illness will positively changed if we correct some myths about it by increasing students knowledge and by giving them the opportunity to contact these group of patients 5.

It is important to understand about Nursing Students attitude towards mentally ill and possible factors which might have lead to the formation of these attitudes. It is very likely that a person’s background and experience may influence his/her attitude towards mentally ill.

6.2 REVIEW OF LITERATURE

Review of literature for this study has been under the following headings

6.2.1 Literature related to positive attitudes towards mental illness

6.2.2 Literature related to negative attitudes towards mental illness

6.2.1 Literature related positive attitudes towards mental Illness

Review of literature is to find out the method for research study. It provides basis to locate pertinent data, new ideas that need to be included to find the comparative data that could be used for supporting present finding and drawing conclusions (Gupta.K, 1997)

A study was conducted to assess the “attitudes of ward attendants towards Mental illness; comparisons and predictions” at G R Mental Hospital, Gwalior, India. The objectives of the study were to explore attitudes of psychiatric ward attendants and which may differ given their cultural and social background. A sample of 100 ward attendants were chosen based on systematic random sampling. The results showed there were no significant differences noted in authoritarianism and benevolence domain, there was significant correlation between age, duration of contact and educational background and various domains of CAMI. The study concludes that psychiatric attendants had more positive attitude towards psychiatric illnesses 1.

A study conducted in Maldives, to assess Nurses attitudes towards the mentally ill in Indira Gandhi Memorial Hospital. A sample of 230 nurses working at the Indira Gandhi Memorial Hospital in Maldives was studied by using a quantitative approach. In this study, nurses were asked to answer on questionnaire consisting of two parts. Part A (Regarding personal and demographics) Independent variable. Part B (The partially revised 40 item CAMI). Dependent variable is the CAMI (Community Attitude towards mentally ill) score main analysis includes descriptive statistics, t-test and ANOVA. Nurses show positive attitude towards mentally ill (mean of 2.65 with standard deviation of 0.50) Maldives have a significantly more positive attitude towards the mentally ills compared to the Indian respondent (F=12.39, P<0.001). Based on the findings, the study concludes that there is limited evidence for relationship between demographic, education and exposive factors with attitude toward mentally ills 6.

In Australia, a study was conducted to assess the “undergraduate Nursing Students’ Attitudes towards Mental Health Nursing and to determine the influencing factors” at School of Nursing. The university of Melbourne Carlton. A sample of 605 Nursing students were included in the study. A structured questionnaire was used to collect the data. The results showed that undergraduate nursing students typically hold unfavourable attitudes towards psychiatric / mental health nursing as a career. This suggest students negative attitudes towards mental illness. The finding also showed significant relationship between students attitudes, beliefs and characteristics and desire to pursue a career in psychiatric mental health nursing 2.

6.2.2 Literature related to negative attitudes towards mental illness

A study was conducted to assess the knowledge, beliefs and attitudes of health care providers towards the mentally ill in Delta State, Nigeria. A sample of 500 health care providers from 44 hospitals were included in the study. A structured questionnaire was used to collect data. The results showed that 296 (61.28%) respondents attitude towards the mentally sick is physical maltreatment, had an attitudinal aggregated score of 1450. only 20 (4.14%) respondents opined care an attitude score is of 35, much more below this studies stated expected attitude mean score of 161, is a strong indication that health care providers attitude is negative. The chi-square value is 27.63 which is greater than the critical value of 9.49. Indicates that the health care providers do have negative attitudes towards mental illness, therefore their medical knowledge do not determine their attitudes towards the mentally ill 4.

Quasi experimental study was conducted to assess the “Attitudes of Jordanian nursing students towards mental illness: the effect of teaching and contact on attitudes change”, at Hashemite University. A sample of 193 Jordanian nursing students were included and data was collected by using a opinion about Mental illness (QMI) Questionnaire. Results showed that the nursing students were found to have positive attitudes towards mental illness, no significant differences were found between student’s attitudes towards mental illness and demographics, there was a significant difference in attitudes towards the mental illness between students who have previous contact with mental patients and those who did not and students attitudes towards mental illness were changed positively in all scales after taking the course 5.

A study was conducted to assess the “attitudes towards mental illness; a comparison of post-basic nursing students with science students’ at Graduate School of Nursing, University of Toronto, Toronto, Canada. A sample of 37 registered general nurses from the faculty of medicine and 15 science students from the faculty of science were included in the study. The OMI scale questionnaire was used to collect data. The study results showed the differences between the nurses and science students not attributable to age were observed in factors like authoritarianism, benevolence and social restrictiveness. And positive correlation was found between authoritarianism and social restrictiveness and also between these two factors and benevolence 3.