Assessing the impact of training on mental health nurses’ therapeutic attitudes and knowledge about co-morbidity: A randomised controlled trial

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Abstract

Background

Substance misuse can trigger or be causally associated with mental health problems. Therapeutic attitude is important in predicting effective engagement with people with alcohol and drug problems but health professionals’ attitudes towards this client group are often negative. Education regarding substance misuse has often been neglected and nurses may lack knowledge to provide appropriate care.

Objectives

To test the impact of training for staff who work with people who have co-existing mental health and substance use problems.

Setting

An NHS Primary Care Division in the West of Scotland.

Participants

Forty-nine mental health nurses.

Methods

Intervention. A four-day training programme. Measurements: (a) therapeutic attitudes measured by the co-morbidity problems perceptions questionnaire; (b) knowledge of alcohol, drugs and co-morbidity measured by a structured questionnaire.

Results

Significant effects for group (F=30.42, p<0.001) were found in therapeutic attitude scores and also over time (F=10.66, p<0.001). A significant interaction was also found (p<0.001). Post-hoc testing revealed that the mean pre-training attitude score was significantly different from post-training (p=0.001; 95% CI 5.53, 25.38) and from six-months follow-up (p<0.001; 95% CI 11.26, 32.49) but that post-training and follow-up mean scores were not significantly different (p=0.358; 95% CI −4.71, 17.55). For knowledge, a significant group effect was found (F=10.32, p=0.002), and also a significant time effect (F=3.35, p=0.039) but no significant interaction effect was present (p=0.169). The post-hoc testing revealed that only a pre-training to six-month follow-up time effect was statistically significant (p=0.005; 95% CI 1.37, 9.29).

Conclusions

The training programme was effective in improving the therapeutic attitudes of participants to working with clients who have co-existing mental health and substance use problems, both immediately after the training was delivered, and at six-months follow-up. It was also effective in improving participants’ overall knowledge of alcohol, drugs and co-morbidity.

Section snippets

What is already known about the topic?

  • Substance misuse can be associated with mental health problems. Therapeutic attitude is an important predictor of effective engagement with this client group.

  • Education for health professionals on substance misuse and on co-morbidity issues is patchy and often inadequate.

What this paper adds

  • The findings of the first reported randomised controlled trial of the impact of training for mental health nurses of an educational programme on issues relevant to working with people who have co-existing substance misuse and mental health problems.

  • The study showed that training can be effective in improving knowledge and attitudes to working with this client group.

Study aim

The aim of the study was to assess the impact of a tailored training programme on the therapeutic attitudes and knowledge of mental health nursing staff with regard to working with people who have co-existing substance misuse and mental health problems.

The null hypotheses were that:

  • 1.

    There will be no significant group or time effect in participants’ knowledge about alcohol, drugs and co-existing substance misuse and mental health problems after the training course has been delivered.

  • 2.

    There will be

Study design

The study was conducted in an NHS mental health service in the West of Scotland as a randomised controlled trial to compare pre- and post-intervention and six-month follow-up measures between an experimental and a control group.

Participants

The population comprised registered nurses who were employed in adult generic mental health and addiction services. A stratified random sample was selected on the basis of staff group, i.e. whether staff worked in generic community mental health teams, generic

Response and attrition rates

From a total of 176 people invited to take part in the study, 49 agreed to participate, representing a response rate of 27.8%. Participant attrition throughout the duration of the study was fairly high at approximately 37%.

Demographic variables

Demographic data for both groups, presented in Table 1, show that the profiles of the experimental and control groups are very similar on the majority of variables. Differences were apparent in the sex distribution, with relatively even distribution being evident in the

Discussion

Given the international prevalence of substance use and mental health problems, this issue is highly relevant to nursing practice world-wide and also in Scotland where the study was conducted. The Scottish Executive has indicated that as many as three-quarters of clients of drugs services and 50% of clients of alcohol services in Scotland may experience a co-existing mental health problem and up to 40% of clients of mental health services may have a concurrent substance misuse problem (Scottish

Conclusion

Alongside other health and social care providers, mental health nurses, have an important role in working with people who have co-existing alcohol and drug related problems (Crome, 1999; Rassool, 2003). It is therefore crucial that staff have the necessary skills, knowledge and attitudes to work with this client group. One way to assist staff to foster such skills and attitudes is through the delivery of effective and appropriate training. This study has shown that a tailored training programme

Acknowledgements

This study was jointly funded by Ayrshire and Arran Primary Care Trust's Research and Development Department, and the Caledonian Nursing and Midwifery Research Centre at Glasgow Caledonian University.

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