2023 Theses Doctoral
Nursing as a Process of Humanization: The Impact of an Undergraduate Mental Health Nursing Course on the Prejudice Toward People Living with a Mental Illness
The stigma attached to mental illness can be more detrimental than the illness itself. The undergraduate mental health nursing course is an optimal time to cultivate students’ positive attitudes toward people living with a mental illness and address the presence of prejudice against such individuals. Two quasi-experimental studies were conducted to determine the impact of an undergraduate mental health nursing course on students’ attitudes toward people living with a general mental illness, depression, and schizophrenia. The first study used a quasi-experimental single-group pretest posttest design. The sample included nursing students (N = 44) in an accelerated Bachelor of Science in Nursing program in New York City. The intervention was the undergraduate mental health nursing course. Students completed pretest data at the beginning of the 2021 summer term and posttest data at the end of the term.
Prejudice toward the mental health conditions of general mental illness, depression, and schizophrenia were measured through the use of three shortened, condition-specific versions of the Prejudice towards People with Mental Illness scale: Prejudice towards People with Mental Illness, Shortened Version (PPMI-SV); Prejudice towards People with Depression, Shortened Version (PPD-SV); and Prejudice towards People with Schizophrenia, Shortened Version (PPS-SV) scale. Each of the three instruments has the same four subscales that represent dimensions of prejudice: fear/avoidance, unpredictability, authoritarianism, and malevolence. Paired-samples t tests were used to analyze the data.
A statistically significant decrease in prejudice scores was found concerning general mental illness (p = .03, d = 0.23), depression (p = .01, d = 0.31), and schizophrenia (p = .013, d = 0.34). Subscale analysis revealed a significant decrease in attitudes of fear and avoidance toward people living with a general mental illness (p <.001, d = 0.46), and schizophrenia (p = .001, d = 0.54), but not for depression. Attitudes regarding the unpredictability of those living with a mental health condition significantly decreased regarding the conditions of general mental illness (p = .016, d = 0.38), and depression (p = .001, d = 0.5), but not schizophrenia (p = .062). No significant change was found in the subscales of authoritarianism and malevolence for any of the three conditions.
The second study used a quasi-experimental, pretest-posttest, nonequivalent-groups design with nursing students (N = 126) from the same accelerated Bachelor of Science in Nursing program in New York City. Participants were assigned either to an intervention group (n = 72), wherein they completed a mental health nursing course, or a control group (n = 54), wherein they completed a pediatric/maternal health nursing course. Data were collected from two cohorts of students in the fall 2021 and spring 2022 terms. All the participants completed a pretest at the beginning and a posttest upon completion of the course. The PPMI-SV, PPD-SV, and PPS-SV were used to assess students' attitudes toward people living with a general mental illness, depression, and schizophrenia. The second study also measured the attitudes toward the recovery of individuals living with a mental illness through the Consumer Optimism Scale. Two-way mixed analyses of variance were used to determine the differences in students’ attitudes. Pearson product-moment correlation analyses were used to assess the relationship between prejudice toward people who experience a mental illness and attitudes toward recovery.
A statistically significant decrease in prejudice toward those living with a mental illness was found among the students who took the mental health nursing course compared to students who took a pediatric/maternal health nursing course (p = .033, partial η2 = .062). There was no significant difference between groups in attitudes toward people living with depression, but a statistically significant decrease was found over time, regardless of the course taken (p = .008, partial η2 = .056). There was no significant change in either group regarding those with schizophrenia, toward whom the highest degree of negative attitudes was found. Furthermore, a subscale analysis revealed that, among the facets of prejudice, the intervention had the most positive impact on fear/avoidance for general mental illness (p = .040, partial η2 = .058) and schizophrenia (p < .001, partial η2 = .164). There was no impact on authoritarian or malevolent attitudes. Additionally, the mental health nursing course had no measurable impact on students' attitudes toward recovery in mental health. However, a moderate-to-strong negative relationship was found between recovery attitudes and prejudice toward people who experience a mental illness (r = -.43 to -.60).
These results show that a mental health course with elements to encourage amelioration of negative attitudes toward those with mental illness led to modest improvements in attitudes. Major curricular reform is needed to optimize the impact of undergraduate education. Possible changes include a more holistic approach toward mental health that does not over accentuate the biomedical model, the use of nontraditional clinical sites that provide students an opportunity to interact with those further along in their recovery, and the inclusion of those in recovery in the curriculum.
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More About This Work
- Academic Units
- Health and Behavior Studies
- Thesis Advisors
- O'Connell, Kathleen A.
- Degree
- Ed.D., Teachers College, Columbia University
- Published Here
- February 15, 2023