|Year : 2021 | Volume
| Issue : 1 | Page : 64-69
Perception of nursing students on recovery of persons with mental illness
Sailaxmi Gandhi1, Maya Sahu2
1 Additional Professor & Head, Department of Nursing, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru, Karnataka, India
2 Ph.D Scholar, Department of Nursing, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru, Karnataka, India
|Date of Submission||06-Oct-2020|
|Date of Decision||27-Jan-2021|
|Date of Acceptance||06-May-2021|
|Date of Web Publication||07-Jul-2021|
Ms. Maya Sahu
Department of Nursing, National Institute of Mental Health and Neuro Sciences (INI), Hosur Road, Bengaluru - 560 029, Karnataka
Source of Support: None, Conflict of Interest: None
The concept of recovery assumes various meanings, depending on the context in which it is raised. The present study aimed at exploring the perceptions of the nursing students about recovery of persons with mental illness (PwMI). Based on convenience sampling and their willingness, 460 undergraduate (UG) and postgraduate nursing students from 85 colleges of nursing in India who came for Psychiatric Nursing clinical experience at the study institute, which is a tertiary care psychiatric institute in South India between May 2017 and December 2018, took part in the study. A semi-structured, self-administered questionnaire was distributed to the students. The data were analysed using statistical software (SPSS 22 version) and P < 0.05 was considered as the level of significance. Majority (86.5%) of the students were females and UGs (77.6%). Among them, 4% had a family history of mental illness. More than half (54.1%) of the students had experience of taking care of PwMI. Results revealed that more than three-fourth (76.1%) of the students had used the term 'recovery' in the psychiatric setting. Majority of them agreed that early detection of mental illness helps in recovery (90.4%), and patient's self-confidence can be increased by keeping him/her busy and engaging in meaningful activities (91.1%). However, nearly 70% agreed that isolating patients with mental illness from family/friends/support groups can be a barrier to recovery. The study provides the preliminary findings of the perception of nursing students on recovery from mental illness. The study has implications on improving the perception on the recovery of PwMI and the need for educating the public on mental illness.
Keywords: Nursing students, perception, persons with mental illness, recovery
|How to cite this article:|
Gandhi S, Sahu M. Perception of nursing students on recovery of persons with mental illness. Indian J Cont Nsg Edn 2021;22:64-9
|How to cite this URL:|
Gandhi S, Sahu M. Perception of nursing students on recovery of persons with mental illness. Indian J Cont Nsg Edn [serial online] 2021 [cited 2021 Dec 1];22:64-9. Available from: https://www.ijcne.org/text.asp?2021/22/1/64/320830
| Introduction|| |
Mental illness is a condition characterised by significant disturbance in thoughts, feelings or behaviour of individuals which result in an enormous social and economic burden to them as well as their families and communities. Caregivers taking care of persons with mental illness (PwMI) face major difficulty in terms of health, finance or social status. Adverse outcomes include caregivers stress, poor health, financial burden, exclusion and discrimination at work and social isolation. Mental disorders were the second leading cause of disease burden in terms of Years Lived with Disability and the sixth leading cause of Disability-Adjusted Life-Years in the world in 2017, posing a serious challenge to health systems, particularly in low-income and middle-income countries.
Recent research has focused on understanding mental disorders and the development of treatments (e.g., medications, trans-cranial magnetic stimulation) that are effective in reducing symptoms. With the use of psychotropic drugs and advancement in treatment and rehabilitation, the meaning of recovery has changed for PwMI.
The concept of recovery assumes various meanings, depending on the context in which it is raised. Much of the notions of recovery remain obscure or are often confused with concepts of remission, cure, readjustment and even rehabilitation. Though the term 'recovery' is generally used for all serious mental health problems without distinction, there is lack of clarity among patients and their families as well as among healthcare professionals, policymakers and researchers.,
For many people with mental illness, the concept of recovery is about staying in control of their life rather than returning back to premorbid level of functioning. Such recovery model does not focus on full symptom resolution but emphasises resilience and control over problems and life.,,
While there is no single definition of the concept of recovery for PwMI, there are guiding principles, which emphasise hope and a strong belief that it is possible for people with mental illness to regain a meaningful life, despite persistent symptoms. There are various factors which actually work as facilitators and some other factors hinder the process of recovery. Further, different healthcare professionals have different perceptions about these factors of recovery. The perceptions of healthcare providers in the community who directly involve themselves with the recovery process for patients with mental disorders may affect the service as well as the outcome.
How healthcare professionals perceive 'recovery' is significantly different from how patients with mental illness themselves perceive this concept., Nursing students provide nursing care to PwMI and their perceptions of recovery may be one of the determinants of the quality and outcome of care that these patients receive. It is important to understand their perception about recovery of PwMI which in turn may help in making some way out to healthy recovery. The present study aimed at exploring the perceptions of the nursing students about recovery of PwMI. Being future healthcare caregivers of PwMI, it is important that their perception of recovery is identified in order to plan interventions or devise more effective strategies addressing those perceptions.
| Methods|| |
This study was part of a non-funded project and only the quantitative aspect of the study that used mixed method was analysed and is reported here. The qualitative part which has been published earlier has been cited for discussion. Undergraduate (UG) and postgraduate (PG) nursing students from various colleges of nursing in India who came for clinical experience to the said institute were invited to participate in the study.
Sample and setting
Based on convenience sampling and their willingness, 460 nursing students (B.Sc. Nursing or M.Sc. in Psychiatry Nursing) from 85 colleges of nursing in India who were posted in a tertiary care institute in South India for Psychiatric Nursing clinical experience between May 2017 till December 2018 were invited to participate in the study. 357 UGs and 103 PG students participated in the study.
Data collection tools/instruments
A semi-structured, self-administered questionnaire which was developed for the study was given to five mental health experts from different disciplines (Psychiatry, Psychiatry Nursing, Psychiatric Social Work and Clinical Psychology) for content validity. The questionnaire was modified after incorporating their suggestions. It was pretested among 9 students and did not require any changes. The finalised questionnaires were distributed to the students to explore their perception about recovery of PwMI.
The questionnaire had two major sections:
- Sociodemographic variables which included age, sex, educational qualification and previous experience of taking care of PwMI
- Perception of recovery which included 10 semi-structured questions with probes. The sub-sections were:
- Concept of recovery (item 1)
- Facilitators for recovery (items 2–6)
- Factors that act as barriers for recovery (items 7–10).
For example, 'Do you use the term 'recovery' in the psychiatric setting?' Yes/No/Don't know. If yes, what do you understand by 'recovery'? This reflects the students' perception about the concept of 'recovery'. Similarly, there were items for facilitators as well as barriers. For instances, 'Do you think that early detection of mental illness helps in recovery? If yes, how?' or 'Do you think that patients with mental illness are being disrespected/ignored due to stigma from professionals? If yes, why do you think so? If no, please justify your answer.' However, scoring was not assigned for the items, rather focus was on the categories of the items which helped to explore the subjects' perception.
Data collection procedure
The subjects were invited to participate in the study at the end of their clinical experience. They were seated in a room and explained briefly about the study. Written informed consent was obtained from them, and data were collected by the researchers/investigators who also clarified their queries. It took approximately 30 min to complete the questionnaire.
The research protocol was reviewed and approved by the Institute Ethics Committee. Permission was obtained from the Principals of the respective colleges. Consenting participants were informed in detail about the assessments. Written informed consent was obtained from all the participants, and they were given freedom to withdraw from the study whenever they wanted. Confidentiality of the participants was assured as the data collection tools did not include any identifying information.
The data were analysed using statistical software (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY, USA: IBM Corp.), and P < 0.05 was considered as the level of significance. Data followed normal distribution. Descriptive statistics such as frequency and percentage was used to describe the categorical variables. Chi-square test was used to find the significant association between socio-demographic variables.
| Results|| |
Description of sample characteristics
Majority (86.5%) of the students were female and UGs (77.6%). Among them, 4% of the students had a family history of mental illness whereas more than half (54.1%) of the students had experience of taking care of PwMI [Table 1].
Perception about recovery of persons with mental illness
More than three-fourth (76.1%) of the students had used the term 'recovery' in the psychiatric setting, and 5.7% were not sure about using the term. Majority (90.4%) of them agreed that early detection of mental illness helps in recovery, and 91.1% agreed that self-confidence of the patients can be increased by keeping him/her busy and engaging in meaningful activities. Around 62% agreed that mental health services contribute to recovery from mental illness, and 79% expressed that patients with mental illness receive some kind of support from their friends/relative/partner. While nearly half of them (48.7%) felt that patients with mental illness were being disrespected/ignored due to stigma from professionals, more than half (57.4%) perceived that patients with mental illness did not get adequate respect from non-professional health workers. However, nearly 70% agreed that isolating patients with mental illness from family/friends/support groups can be a barrier to recovery. A total of 21.1% of students were not sure and were unable to answer whether mental health services were helpful in recovery of patients [Table 2].
|Table 2: Frequency and percentage distribution of the subjects based on perception of recovery|
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The study also examined the association between students' perception about recovery and previous experience of taking care of PwMI [Table 3] and education [Table 4]. The Chi-square test indicated that there was no association between the experience of taking care of PwMI and perception of recovery and agreement to facilitators for recovery such as early detection, engagement in meaningful activities, importance of mental health services and received social support. However, significant association was found for the statement that PwMI are disrespected due to stigma from professionals (χ2 = 11.11, P = 0.004) or non-professional health workers (χ2 = 11.46, P = 0.003). The students who had experience of taking care of PwMI had better perception (χ2 = 10.76, P = 0.005) that isolating PwMI can be a barrier of recovery than who did not have.
|Table 3: Association between previous experience of taking care of person with mental illness and perception about recovery|
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When considering the educational status, there was a significant association between the level of education and the perception of recovery and agreement to some facilitators like early detection and mental health services and barriers like isolating PwMIs. In all the above aspects, larger proportion of PG students agreed to facilitators of barriers.
| Discussion|| |
The present study highlighted the findings of perception of nursing students regarding recovery of PwMI. The findings were corroborated with previous findings.
Majority of the participants were female (86.5%), which indicates the fact that nursing in India is still a female-leading profession though there is a gradual increase of males in nursing over time in various states. The study sample comprised 77.6% of UG nursing students. Majority (96%) of the students did not have family history of mental illness whereas more than half (54.1%) of the students had experience of taking care of PwMI. A study conducted among nursing students in Indonesia found that 93.7% did not have family history of mental illness and 69.4% knew or had direct contact with PwMI.
Majority of the subjects used the concept 'recovery' when taking care of PwMI and were aware of its facilitators and barriers. This is in line with results reported by previous studies which had found different notions of recovery of PwMI., Earlier, in his emergent concept of recovery, Ramon et al. stated that is not about going back to a previous pre-illness state, instead it is about forging a new way of living controlled by the newly found self-agency of users. However, recovery is a theme dominated by service users and is often defined in terms of an ongoing process requiring a change in attitudes and values.
Studies showed that clinicians' perception was significantly different from patients' and their relatives' perception of recovery.,, A systematic review of qualitative studies found that for the patients, recovery is a complex process and is shaped or completed by individual, familial, societal and illness orientation. For them, recovery meant regaining the previous potentials and going back to the normal or pre-morbid stage. Further, the patients considered recovery as being free from symptoms of the illness and thereby achieving effective functioning, whereas Lahera et al. reported that psychiatrists are more concerned with the clinical aspects of the disease. Although students who participated in the present study used the term recovery and perceive it as a possibility for PwMI, the study did not explore what meaning they attach to the concept of recovery.
Several associated factors were identified in this study. First, having experience of taking care of PwMI was associated with having the notion of possibility of recovery. Having an experience of taking care of PwMI gives an opportunity for students to better understand the possibility of recovery in mental illness. This is consistent with findings from a qualitative study conducted among healthcare students which found that direct contact with PwMI positively impacted them and led to increased awareness of the problems of mental illnesses. Similarly, a study conducted among pharmacy students showed that direct and indirect contact experiences with PwMI can help reduce stigma. Previous literature reported that stigmatisation and social barriers had an impact on recovery. Moreover, social stigma, discrimination and perceived self-stigma were significant negative predictors of recovery.
The current study also documented that the students perceived that PwMI were disrespected due to stigma from professionals, but a higher percentage of students (57.4%) disagreed with the statement that they received adequate respect from non-professional health workers. These findings are reflected in previous literature where medical doctors or mental health professionals were found to have less stigmatising attitudes towards PwMI than the general public., This may be attributed to the fact that better knowledge of mental illness by professionals may lead to favourable attitude towards them. In addition, the training and education received by the healthcare professional may make a difference in better understanding of mental illness.
The present study findings also showed that the students who had experience of taking care of PwMI were more likely to agree that isolating PwMI from their families/friends actually hinder recovery. It is plausible that these perceptions may help in better care of PwMI. Role of family is important in recovery of PwMI particularly in Indian context, as families are closely involved in treatment, support, recuperation and rehabilitation of individuals with mental illness, and remission rates are comparatively higher., This also helps reduce distress through active engagement in meaningful activities and being with people.
Second, education was also associated with having better perception of recovery. Although UG students were more likely to agree that additional factors acted as facilitators and barriers of recovery, a significantly higher number of UG students responded don't know for the same statements than the PG students probably due to comparatively less exposure of UG students to the PwMI than PG students who are specialising in Psychiatric Nursing who had longer duration of clinical practice hours. However, frequency distribution of UG and PG ratio was 3.5:1; hence, this conclusion cannot be made and the findings should be interpreted cautiously.
Strengths and limitations
The main strengths of the present study were inclusion of students who came from many other states of India which may be representative of the country and hence increases the possibility for generalisability of the findings. Using semi-structured, self-reported questionnaire was one of the limitations of the study as response bias could not be avoided. Further, this study reports only the quantitative aspect of a mixed-method approach which restricted the integration of both the findings.
| Conclusion|| |
The study provides the preliminary findings of nursing students' perception of recovery from mental illness. Their perception of facilitators and barriers towards recovery from mental illness may affect the care they provide to the PwMI. Further, their experience of taking care of such individuals also has significant impact on their perception towards it. Hence, the study has implications on improving the perception of recovery among the nursing students and also highlights the need for educating people towards mental illness, particularly interventions that are aimed at improving perception of recovery of PwMI.
The authors would like to thank all the subjects for participating in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]