An evaluation of a reorientation training programme in changing nurses attitudes towards the provision of mental health care.

Abstract

The transition from the apartheid rule to a new democracy in South Africa has been accompanied by a vision of a national health care system that is based on the principles of universal primary health care. This vision opens up access to provision of mental health to everyone. This means that nurses, as gate-keepers of primary health care, have had to be trained in identification and management of minor mental health problems that are presented in their community clinics as well as health centres. For the current study, the need for such training was identified by an intern psychologist placed in one of the clinics in the area of KwaDedangendlale Valley of a Thousand Hills. His work in the area alerted him to the shortcomings of the nurses in both identification and management of what was perceived to be mental health problems. These shortcomings included the nurses' inability to identity and hence properly refer patients who needed the intervention of a professional mental health specialist. From this, a training programme which also included a reorientation process to deal with negative attitudes that are usually levied against the mentally ill was undertaken. Reorientation in this context was based on the assumption that prior to training nurses had a particular world view or position towards the provision of health care, which was identified to be biomedical and this training sought to re-orientate them towards the provision of a more holistic care which is inclusive of psycho social aspect of functioning The follow up to that training and reorientation programme was an evaluation component. This sought to ascertain whether after training, nurses were better equipped to identify and manage mental health problems. Further to that, the researcher sought to identify whether their attitudes had improved, such that they would be willing to deal with patients who presented with minor psychiatric problems. The objective of the current study is to present results of the evaluation component that was undertaken after training. This evaluation took into consideration both the process undertaken during training and the outcome of the reorientation process itself. Process evaluation focused on what makes a programme successful or unsuccessful. This included how the training was undertaken, i.e. manner of instruction etc. Outcome evaluation focused on establishing how good the programme was and whether it managed to provide desired outcomes i.e. change in nurses' attitudes. The Physician's Belief Scale (Ashworth, Williamson & Montano, 1984) was used for both the pre and post evaluation of the nurses' attitudes. The results revealed that before training, nurses had limited knowledge of mental health problems and as a consequence of this limited knowledge they developed negative attitudes towards provision of mental health care. One of the unexpected results of the study was the response of one of the groups of the nurses trained to the integrative manner of instruction. Their response highlighted the importance of understanding the influence of the padagogy on knowledge transmission and acquisition. Nurses reported to be accustomed to harsh pedagogical methods, used during formal nursing training. This kind of pedagogy was viewed as disempowering, as well as somewhat disrespectful, and hence, the much as the friendly and warm atmosphere presented by the facilitators in the current study was viewed as a welcomed change and an empowering process. Most importantly, one was also alerted to the importance of providing ongoing support to health care professionals after being trained. As Petersen (2000) has cautioned that should there be no additional mentoring or support, nurses would be likely to revert to their usuaVold styles of dealing with their patients' problems, given that the training does not necessarily change their environments. They would still be pressured to see large numbers of patients within a limited time period. And because of this, it becomes easier to just prescribing medication than to explore issues that are psychological in nature.