4. CONCLUSION
5.3 PERCEIVED KNOWLEDGE, SKILLS AND ATTITUDES OF NURSES REGARDING
5.3.1 Perceived knowledge regarding mental health management in HIV/AIDS
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5.3 PERCEIVED KNOWLEDGE, SKILLS AND ATTITUDES OF NURSES
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mental health care. The main focus of their study was on rural generalist nurses perceptions of the effectiveness of their therapeutic interventions for patients with mental illness. Their findings revealed that 70% of the respondents indicated that limited knowledge of mental health problems was an issue preventing nursing staff in rural and remote settings from providing optimum care to patients with mental illness.
Furthermore, 29% of the respondents indicated that they had never received or undertaken training or education in relation to the care, treatment or assessment of patients with mental illness. It further stated that rural nurses do not feel competent, nor adequately supported, to deal with patients with mental health problems. However, according to Clark et al. (2005), nurses play an integral role in the delivery of health care services to people suffering from mental illness in rural and remote areas of Australia.
Nurses have a higher frequency of contact with PLWHA than most other health care providers (Delobelle, Rawlinson, Ntuli, Malats, Decock and al, 2009). However, nurses are not usually competent enough to deal with mental health problems (Svediene et al., 2009; Atkin, Holmes and Martin, 2005). The findings of the current study suggested that PLWHA are not always attended by nurses who are competent enough to deal with mental health care problems.
This is consistent with the findings of Chorwe-Sungani’s, (2010) Malawian study, where nurses provide the majority of health care in general settings. The findings showed that many nurses perceived that they lacked knowledge and skills to deal with mental health problems. The fact that PLWHA may not always access relevant mental health care in general settings defeats the very purpose of the National Mental Health Policy of Malawi (Ministry of Health and Population [MOHP], 2001) which advocates for the provision of mental health care in general settings.
This is supported by other studies that have indicated that nurses must have adequate knowledge and skills to deal with mental health problems of people living with HIV/AIDS (Collins , Holmand , Freeman and Patel 2006; Freeman et al., 2005) because they are usually the frontline health care providers in general settings (Atkin et al., 2005; Lauder et al., 2002). Rural generalist nurses require knowledge, skills and networks in mental
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health that will enable them to provide effective mental health care, but a number of studies have suggested that undergraduate nursing students are not specifically prepared for work in the mental health field (Moxham, Dwyer, Happell, Reid‐Searl, Kahl, Morris et al., 2010; Clark et al., 2005). Gorman, Buikstra, Hegney, Pearce, Rogers‐ Clark, Weir et al. (2007) found that nurses believed the amount and type of support services available impacted upon their scope of practice.
From the findings of this study, it is clear that nurses have varying perceptions about their levels of knowledge, skills and competency to care for people living with HIV/AIDS who have mental health problems. Clark et al. (2005); Lauder et al. (2002); and Lethoba, Netswera, and Rankhumise (2006), in their nursing literature, have stated that nurses’ self-perceptions in this regard have an influence on their nursing interventions.
This may probably mean the quality of mental health care that is received by PLWHA may vary according to the nurse’s level of role competency. Other studies (Chorwe- Sungani, 2010 and Uebel,2013) have indicated that having adequate knowledge and skills evokes positive self-perceptions about mental health care in a nurse and this helps in rendering and ensuring the therapeutic interaction and understanding of the client needs (Mavundla, 2000).
With regards to the variable on whether respondents had received mental health training or not, respondents gave the following responses: of the 39 registered nurses, only 15 (38.5%) had received mental health lecturers, while 24 (61.5%) had not; of the 15 registered midwives, 9(60.0%) had received mental health lecturers, while 6 (40%) had not received the mental health care lecturers, of the 54 registered psychiatric, community and midwifery nurses, 44 (81.5%) had received mental health lectures, while 10 (18.5%) had not, of the 2 registered psychiatric nurses, 1 (50%) had received mental health lecturers and 1 (50%) had not; and of the 14 registered PHC nurses, 4 (28.6%) had received mental health lectures and 10 (71.4%) had not. In summary, of the 124 nurses who responded to the questionnaire, 73 (58.9%) had received mental health lectures and 51 (41.1%) had not.
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It is significant that nurses are adequately equipped with enough knowledge and skills to care for people with mental health care problems and for the nurses to be able to understand the relationship between HIV/AIDS and mental health problems. In this study, the majority of the respondents reported that they had received mental health care lecturers during their training. It is however noted that many nurses have demonstrated low levels of role competency. This was found in the responses of the respondents who completed in the questionnaire. It is assumed, therefore, in this study that the low levels of role competency that were demonstrated by nurses were evoked by lack of in-service education of nurses on how to deal with mental health problems in PLWHA. This is in line with the study conducted by Munro et al. (2007) who proposed that effective and appropriate training helps nurses to improve their knowledge, skills and attitudes regarding mental health care. Training in mental health promotes confidence in nurses and in their dealing with mental health problems in general settings (Moxham et al., 2010). It is argued in some literature that nurses who did not receive any mental health care lectures have little interest in caring for PLWHA and people with mental health problems (Lauder et al., 2002). It was interesting to note that there are nurses from this study who are willing to care for PLWHAs who present with mental health problems provided they receive adequate mental health care lecturers and in-service education training and this was shown in their responses on the statement “I am interested in the nature of mental health problems of people living with HIV/AIDS and the treatment of them’’.
Findings of studies conducted in Singapore and Turkey by Ngan et al. (2000) and Bektas and Kulakac, (2007) respectively, revealed that nurses’ levels of anxiety in caring for people with HIV/AIDS were reduced by education. In South Africa, similar findings were highlighted in studies conducted by Madumo and Peu (2006); Lohrmann, V¨alim¨aki, Suominen, Muinonen, Dassen and Peate (2000); Petro-Nustas, Kulwicki and Zumout (2002). Rondahl, Innala and Carlsson (2003) concluded that there was a need for nursing education not only to have biomedical knowledge of HIV/AIDS, but also that education should include broader cultural and ethical issues surroundings in HIV/AIDS.
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5.3.2 Perceived skills regarding mental health management in HIV/AIDS services