Effect of Self-instructional module on Knowledge and Attitude on Legal aspects of Psychiatric care among nurses

 

Sujitha T S

St. James College of Nursing, St. James Medical Academy. Chalakudy, Kerala

 

ABSTRACT:

 

 

INTRODUCTION:

To practice psychiatric-mental health nursing, nurses must understand the basic legal aspects of caring for psychiatric clients. All nurses are expected to know the rules and regulations for nursing practice in the states in which they are licensed to practice. In specialties such as psychiatric or mental health nursing, nurses are responsible for acquiring and maintaining competency through appropriate education, knowledge, training and experience.¹

 

Knowledge of the legal boundaries governing psychiatric nursing practice is necessary to protect the public, the patient and the nurse. The practice of psychiatric nursing is influenced by law, particularly in its concern for the rights of patients and the quality of care they receive.²

 

Nurses are one of the largest groups of professionals working in the health care system. Their presence in the health care system plays a very important role and helps in the speedy recovery from the illnesses.³

 

Nurses who provide care to mentally ill should be conversant with the current legal and ethical problems in order to ensure adequate care for the patient. There has been a dramatic increase in the number of mental health related law suits in the last 30 years which makes it imperative for the mental health professionals to keep current acquaintance with the law. Psychiatric patients are least capable of protecting their rights because of their illness. Mental health patients have the same legal rights guaranteed to everyone by the constitution and other laws.

 

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of self instructional module on knowledge and attitude regarding legal aspects of psychiatric care among nurses at selected psychiatric hospital in Thrissur.

 

OBJECTIVES OF THE STUDY:

1)   To assess knowledge and attitude of nurses regarding legal aspects of psychiatric care before the administration of self instructional module.

2)   To evaluate the effect of self instructional module regarding legal aspects of psychiatric care among the nurses at selected psychiatric hospital in Thrissur.

3)   To find out the association of pretest knowledge and attitude score regarding legal aspects of psychiatric care among nurses with their selected demographic variables.

 

HYPOTHESES:

All hypotheses will be tested at 0.05 level of significance:

H₁    There is a significant difference between the scores obtained by the nurses on knowledge and attitude regarding legal aspects prior to and after the self instructional module.

H₂    There is a significant association of pre-test knowledge score of nurses with their selected demographic variables.

H₃    There is a significant association of pre-test attitude score of nurses with their selected demographic variables.

 

MATERIALS AND METHODS:

Quantitative approach was used for the study. Samples were 30 staff nurses working in Elite Mission Hospital, Thrissur. Who fulfill the inclusion criteria were selected using Simple random sampling technique.

 

Operational Definition”

Effectiveness”

It refers to the extent to which self instructional module will increase the knowledge and attitude regarding legal aspects of psychiatric care among nurses working at selected psychiatric hospital in Thrissur, which will be measured by post test with the help of structured questionnaire.

 

Self instructional module:

It refers to an independent learning material systematically developed by researcher regarding legal aspects of psychiatric care which include the admission and discharge procedure and maintaining confidentialty among psychiatric patients that enhances the knowledge and attitude regarding legal aspects of psychiatric care among nurses at selected psychiatric hospital in Thrissur.

 

Knowledge:

It refers to the correct responses to the knowledge questionnaire regarding legal aspects of psychiatric care that will be quantified.

 

Attitude:

It means a way of thinking and feeling about something. In the present study it refers to nurse’s feeling regarding legal aspects of psychiatric care that will be assessed by attitude scale developed by researcher.

 

Legal aspects of psychiatric care:

It include the legal implications to be observed during admission and discharge procedure and maintaining confidentiality among psychiatric patients.

 

Nurses:

It refers to the nurses who are registered and qualified with General Nursing Midwifery or Post Basic BSc Nursing or Bachelor of nursing and taking care of the psychiatric patients in the selected psychiatric hospital in Thrissur

 

Selected psychiatric hospital:

It means the hospital which provide admission to psychiatric patients. In this study, it is the Elite Mission Hospital, Thrissur.

 

Sample:

The sample size was 30.

 

Tool/Instruments:

Section A: Socio demographic variables:

Section B: Structured knowledge questionnaire:

A structured knowledge questionnaire was constructed to assess the knowledge of nurses regarding the legal aspects of psychiatric care.

 

Section C:Attitude scale:

A likert type attitude scale was developed to assess the attitude of nurse regarding legal aspects of psychiatric care.

 

Pilot study:

Pilot study was conducted at Ansar Institute of Psychiatric Medicine and Rehabilitation, Thrissur, after obtaining formal permission from the concerned authorities and the researcher found that the study was feasible.

 

Data Collection Process:

The data collection for main study was conducted in Elite mission hospital,Thrissur.The investigator obtained written permission from the concerned authorities prior to the data collection period.Samples were selected by simple random sampling.A written informed consent was taken separately from each sample.Appropriate orientation was given to all the samples about the aim of the study and nature of the tool.

 

Pre-test was conducted by distributing the questionnaire.The time taken for the completion of the pretest was 45 minutes.Soon after the pretest,SIM regarding legal aspects of psychiatric care was given.The participants were given chance to clarify the doubts and concerns.On seventh day post-test was conducted using the same tool to determine the effectiveness of SIM.

 

RESULTS:

Section I:

Distribution of nurses according to socio-demographic variables in frequency and percentage:

The distribution of subjects in relation to their age group revealed that most of the subjects (76.7%) were in the age group of below 25 years. Remaining 16.7% of subjects belong to 25 - 35 years age group, 6.6% were in the age group of 36 - 45 years.

 

Distribution of subjects in relation to gender revealed that most of the subjects (83.3%) were females and only 16.7%) were males.

 

Distribution of subjects in relation to their religion revealed that 33.3% were belonged to Hindu religion, 60.0% of subjects were belong to Christian religion, and 6.7% of subjects were belong to Muslim religion.

 

Distribution of subjects in relation to place of residence revealed that 6.7% of subjects lives in urban area,70.0% of subjects lives in semi-urban area and 13.3% of subjects lives in Rural area.

 

Distribution of subjects in relation to type of family revealed that the type of family of 43.3% subjects were nuclear, the type of family of 56.7% subjects were joint and none of them were having extended type of family.

 

Distribution of subjects in relation to their Educational Status revealed that 76.7% had GNM, 16.7 had B.Sc Nursing and 6.7% had Post basic B.Sc Nursing and none of them had M.Sc Nursing.

 

Distribution of subjects in relation to Clinical Experience revealed that 96.7% had below 10 years experience,3.3% had experience between 10 - 20 years and none of them had experience of more than 20 years.

 

Distribution of subjects in relation to clinical experience in psychiatric ward revealed that 100% had <5 years experience in psychiatric department.

 

Distribution of subjects in relation to their current area of work revealed that 76.7% were working in psychiatric ward,23.3% were working in Psychiatric ICU and none of them were working in Outpatient Department.

 

Distribution of subjects in relation to Number of In Service Education Attended revealed that 83.3% had never attended the In Service education regarding legal aspect of psychiatric care. Remaining 16.7% had attended the In service education regarding legal aspects of psychiatric care less than 5 times.

 

Distribution of subjects in relation to ever faced any legal issues in psychiatric area revealed that 6.7% had experienced the legal issues in psychiatric area and 93.3% had never faced any legal issues in psychiatric area.

 

Section II:

Analysis and interpretation of Pre-test knowledge and attitude of nurses regarding legal aspects of psychiatric care:

It is found that 76.7% nurses had poor knowledge and 23.3% nurses had moderately adequate knowledge and none of them had adequate knowledge regarding legal aspects of psychiatric care in pre test.

 

It is found that 46.7% nurses had negative attitude regarding legal aspects of psychiatric care and 33.3% nurses had positive attitude regarding legal aspects of psychiatric care. Remaining 20% nurses had strong positive attitude regarding legal aspects of psychiatric care. None of them had strong negative attitude regarding legal aspects of psychiatric care.

Section III:

Analysis and interpretation of Post-test knowledge and attitude of nurses regarding legal aspects of psychiatric care:

It is found that 6.7% nurses had moderately adequate knowledge regarding legal aspects of psychiatric care and 93.3% nurses had adequate knowledge regarding legal aspects of psychiatric care. None of them had poor knowledge regarding legal aspects of psychiatric care.

 

It is found that 6.7% nurses had positive attitude regarding legal aspects of psychiatric care and 93.3% nurses had strong positive attitude regarding legal aspects of psychiatric care. None of them had strong negative and negative attitude regarding legal aspects of psychiatric care.

 

Section IV:

Analysis and interpretation of effectiveness of SIM by comparing pre-test and post-test knowledge and attitude scores regarding legal aspects of psychiatric care among nurses:

The mean pretest knowledge score was 11 and mean post test knowledge score was 22.83 with standard deviation of 2.393 and 2.640 respectively.The calculated t value was 16.947.The significant p value (p<0.001) suggested that the administration of SIM was effective in changing the knowledge of nurses regarding legal aspects of psychiatric care.

 

The mean attitude score before the administration SIM was 34.00 with SD 8.149. After the administration of SIM the mean attitude score was 47.63 with SD 4.460. It is inferred that the increase in knowledge and attitude score of nurses improved in post-test is due to self instructional module.

 

Section V:

Analysis and interpretation of association between the selected socio demographic variables and the pre test knowledge and attitude scores:

 

A) Association between pre-test knowledge score and selected socio demographic variables:

The non significant P value showed that there was no association between pre-test knowledge score and selected socio demographic variables such as age in years,gender,religion,place of residence,type of family, educational status, current area of work, number of in service education attended.Hence the null hypothesis was not rejected.

 

B) Association between pre-test level of attitude and selected socio demographic variables:

The significant P value showed that there was an association between pre-test attitude score and selected socio demographic variables such as age in years, educational status, number of in-service education attended. Hence the null hypothesis was rejected for age in years, educational status, number of in-service education attended.

 

The non significant P value showed that there was an association between pre-test attitude score and selected socio demographic variables such as gender, religion, place of residence, type of family, current area of work. Hence the null hypothesis was not rejected for the variables gender, religion, place of residence, type of family, current area of work.

 

DISCUSSION:

The findings were supported by the study which was conducted to assess the nursing personnel’s knowledge of human rights of mentally ill showed that 17 (34%) nursing personnel had inadequate knowledge,24 (48%) nursing personnel had moderately adequate knowledge and remaining 09(18%) nursing personnel had adequate knowledge.⁴

 

The findings were supported by the study which was conducted to assess the attitude of staff nurses regarding rights of hospitalized psychiatric patients showed that the in graduate nurses who contains 50% of the sample, 83.4% had unfavorable attitude and remaining 16.6% had favorable attitude. In diploma nurse who contains 50% of sample,100% had unfavorable attitude.⁵

 

CONCLUSION:

The treatment of psychiatric patients raises legal issues that ordinarily do not arise in the treatment of other illnesses.So the nurses working in the psychiatric set-up must know the legal aspects of psychiatric care.To increase the level of knowledge and attitude of nurses, the investigator came to a conclusion that, the best method to improve the knowledge and attitude of nurses is providing the self instructional module.

 

REFERENCES:

1.      Linda Carman Copel.legal aspects of psychiatric-mental health nursing.Available from: http://www.homesteadschools.com/lcsw/courses/PsychiatricMental/Chapter02.html

2.      R. Sreevani. Mental Health and Psychiatric Nursing. 2^nd Edition. New Delhi: Jaypee Publishers; 2008.

3.      Mary C. Townsend. Psychiatric Mental Health Nursing. 5th Edt. New Delhi: Jaypee; 2007.      

4.      Nagaraja. D. The nursing personnel’s knowledge of human rigts of mentally ill in two government psychiatric hospital. Arch Gen Psychiatry [Internet].2006 Aug 12 [cited 2012 Jan 13]:40(4)[about374-77p.].Availablefrom: http://archpsyc.jamanetwork.com/article.aspx?articleid=5982036.

5.      R. Sreevani, R. Revathi. A study to assess the attitude of staff nurses regarding rights of hospitalized psychiatric patients in selected hospital, Kolar. Indian Journal of Holistic Nursing. 2010 June 6: 1:27-31.

 

 

 

Received on 10.10.2019          Modified on 20.11.2019

Accepted on 26.12.2019   © A&V Publications all right reserved