Mental health nurses' measured attitudes to people and practice: Systematic review of UK empirical research 2000–2019

Abstract

What is known on the subject?• Many studies have investigated the attitudes of mental health nurses towards a range of targets. These targets are person-oriented (for example groups of people with a similar mental health diagnosis) or practice-oriented (for example practices such as seclusion or restraint).• It is thought that attitudes contribute to the practice of mental health nurses because research suggests attitudes have a role in shaping behaviour. What the paper adds to existing knowledge?• To date, research about mental health nurses' attitudes has examined different attitudes in isolation from one another. By demonstrating a lack of connectedness across studies this paper highlights the need for new theory-informed approaches to attitudinal research.• By standardizing measurements across different studies this review demonstrates that the most negatively appraised attitudinal targets-indicated by large proportions of respondents who appraise negatively-concern people with diagnoses of borderline personality disorder, substance misuse, and acute mental health presentations. What are the implications for practice?• Significant numbers of mental health nurses may have attitudes, especially towards people with borderline personality diagnoses and those who misuse substances, that may not be concordant with good practice.• There is insufficient evidence about what the actual implications this has for practice because the body of relevant research lacks coherence, interconnectedness and a grounding in contemporary theoretical developments.• Training programmes that focus on attitudinal change need to be more rigorously evaluated.

Crisis resolution home treatment team Clinicians' perceptions of using a recovery approach with people with a diagnosis of borderline personality disorder

“…Or comments, such as "a lot of practitioners don't feel happy with supporting people with that diagnosis … because they are risky, and it scares them" (P1) suggest that there is a danger of not delivering optimal care because of the perceived level of risk. The latter echoes the evidence of nurses overestimating the assumed dangerousness of this client group (Dickens et al, 2022). Given the evidence that people with this diagnosis are often aware of the stigma attached (Lamph et al, 2022), it has to be considered that there is a danger that this complex tension of riskmanagement and labelling will be unconsciously communicated to the service users and negatively impact on their experience of care.…”

Mental health nurses' attitudes towards risk assessment: An integrative systematic review

“…This has potentially important implications given that one important rationale for investigating attitudes is the well‐established theory that they influence behaviour (Ajzen, 1985). Such theory has been widely cited to support attitudinal research in mental health nursing across a range of topics (Dickens et al, 2022). Consequently, the ability to discriminate between those with different attitudinal sets provides an opportunity to understand their role in risk assessment.…”

“…Another aspect that has gained research attention is the study of mental health nurses' attitudes. This is largely because of both the theoretical and measurable links between attitudes and practice including behaviour towards and relationships with patients (Dickens et al, 2022). Mental health nurses' attitudes have been considered important in shaping their practice in specific domains including the use of containment measures for disturbed behaviour or management practices for self‐harm (Bowers et al, 2007; Hosie & Dickens, 2018).…”

Coercive containment measures for the management of self‐cutting versus general disturbed behaviour: Differences in use and attitudes among mental health nursing staff

“…2009), they have not been extensively investigated in terms of their relationship with other constructs or with actual practice behaviour (Dickens et al . 2022). Partly as a result of this, there is also some room for doubt about the meaning of attitudinal ratings.…”

“…This provides further evidence that study of attitudes to containment measures as a construct needs additional nuancing to account for differences dependent on the reasons for its use. While these attitudes have achieved a certain amount of research attention (Bowers et al 2004(Bowers et al , 2007Whittington et al 2009), they have not been extensively investigated in terms of their relationship with other constructs or with actual practice behaviour (Dickens et al 2022). Partly as a result of this, there is also some room for doubt about the meaning of attitudinal ratings.…”