Too much attention takes the form of over sedation, over observation, isolation in a side room and even physical restraints. The attitudes, which give rise to the above, are deeply rooted in society (Nordt et al 2006). The concept of schizophrenia is often associated with fear of the potential threat of patients with such illness. People’s misconception about schizophrenia is engendered by the false equivalence of schizophrenia with split personality (Angermeyer, Matschinger 2004). Thornicroft (2006, pp. 27) reaffirms the above by stating, “popular knowledge about mental illness is a potent cocktail of profound ignorance and pernicious misinformation”.
Among the component of the public stereotype of schizophrenia, the most prevalent is that people with this disorder are unpredictable and incompetent. Next comes the perception of dangerousness followed by the anticipation of poor prognosis and that the disorder is feigned or imaginary. Other stigmatising beliefs include: the disorder is self-inflicted, that it reflects a weakness of character and that it is incurable.
For effective health care to be delivered it is crucial that nurses are not hampered by prejudiced attitudes. Personal experience indicates that nurses should not be complacent: “We’ve got a nutter for you” is a common term used by staff members during handover of a patient who suffers from a mental illness.
Newly registered nurses who have been exposed to psychiatric wards during their training often have more realistic attitudes towards schizophrenia and other mental health problems. This implies that the stigma of mental illness can be reduced by education and experience, and that examination of attitudes towards mental illness should be included in training (Corrigan et al 2005).
Hanley (2006) highlights ways to reduce stigma in a recent report, which in turn will help to overcome the challenges it causes to nursing care. They include: Examine our own attitudes; update our knowledge of mental illness; listen to what patients say about mental illness and its consequences; watch out for stigmatising language; and to be an advocate for those with a mental illness.
To elaborate further on a few of the above: Maintaining up to date knowledge of schizophrenia and mental illness leaves less room for stereotyping to creep in (Baston, Simms 2002). If nurses recognise their patients as unique individuals and not as illnesses, it is harder to stereotype and hold stigmatising attitudes towards them (Brammer 2006). General nurses need to make an effort to curb the use of potentially stigmatising language, such as describing patients as if they were their illness. Describing a patient as a ‘schizophrenic’, rather than someone who has schizophrenia reduces them to a stereotype and robs them of personal identity.
Too often the patients bizarre behaviour drives the nurse away, especially when the illness intrudes on the patients ability to use ordinary human communication (Arnold, Hallinan 2000). Arnold and Hallinan (2000) also state that this problem can be so frustrating for both the patient and nurse that each is unable to respond to the potential inherent in the therapeutic encounter. Nurses often adopt this stance because they are not familiar with these problems and how to work with them. According to Janosik and Davies (1996), for general nurses caring for patients with schizophrenia; there is no precise set of rules or techniques that are uniformly applicable.
Good communication is the most important aspect of care (Arnold, Boggs 1999). According to Vazquez (2001) whenever a patient is not accepted as a unique human being and their communication efforts are not acknowledged in a caring, honest manner, they may feel that their legitimate needs have not been sufficiently fulfilled. The patient who has schizophrenia needs to know that the nurse is attempting to understand the obscure message that they are verbally and behaviourally conveying (Arnold, Hallinan 2001).
Personal experience of observing a specialist mental health nurse intervene an encounter between a general nurse and a patient with schizophrenia identified the importance of communication. It also revealed the challenge faced by general nurses. The mental health nurse was able to penetrate the patient’s world to obtain information by creating a rapport between the two of them. This helped the patient to accept the nurse and gain the confidence and sense of security to express his problems to her. To approach the patient with expertise the nurse needed the appropriate baseline knowledge and a range of behavioural skills such as being authentic and genuine.
The ability to empathise and understand the patient’s reality as well as perceiving their feeling was developed by actively listening. This encouraged the patient to acknowledge that somebody was there to pay attention to what he was saying.
This experience identified the need to be open minded and learn more about the diversity of schizophrenia and that portraying a positive attitude towards the patient improves communication (Tay et al 2004).
A good relationship with nurses is important for everyone who is ill, but it is particularly important for those who have a sever mental illness such as schizophrenia. Good communication on the part of nurses is essential in developing that nurse-patient relationship which is necessary in the treatment of schizophrenia (Eisen et al 2000). This relationship is not served if nurses do not make an effort to understand the experiences and point of view of patients with this disorder and exclude them from participation in decision-making.
The nurse’s sense of powerlessness is another challenge that constrains nursing care. Issues such as insufficient education and training, time constraints and lack of resources and expert assistant contribute to this powerlessness.
Nurses require specific knowledge and skills to maintain a therapeutic environment and relationship when caring for patients with schizophrenia. According to Happell and Sharrock (2001) nurses working on non-psychiatric settings report that they do not feel adequately prepared to meet the mental health needs of the patients. They go on to state that, in particular general nurses report a lack of knowledge, skills, confidence and the essential nursing competences in the assessment and management of mental health problems in the patients. The lack of such skills make it difficult to provide appropriate care to these patients in the general healthcare setting where acute medical problems may be the focus of the nurses attention.
Dealing with patients’ pressures and difficulties without the appropriate training can evoke stresses and anxieties for staff, which are not consciously known about, but which nevertheless impinge upon the quality of care delivered (Arnold, Hallinan 2000).
Time constraints prevent nurses from providing high quality of care for these patients. The importance of communication and creating a rapport, which was mentioned previously, is almost impossible in the busy atmosphere of a general ward.
Greater support from specialist mental health nurses would improve nursing care (Arnold, Hallinan 2000). The nursing staff would benefit from assistance in cases where the mental health needs of the patient are beyond the expertise of the staff, or the psychotic symptoms interfere with treatment, have implications for nursing care, present risks to patient, staff and others and are disturbing or perplexing for staff (Fisher 2002).
Conclusion
In most cases general nurses are not prepared to address the mental health needs of patients with schizophrenia. With proper training and supervision, nurses could become more competent in treating mental disorders. Unlike those with physical illness people with schizophrenia are generally subjected to stigma and prejudice. The stigma is often due to public ignorance about the underlying causes of schizophrenia. One of the challenges for nurses is to create an understanding of schizophrenia and other mental health problems for both the general public and themselves. People with schizophrenia are perceived as difficult to communicate with but to over come this the nurse must convey a sincere wish to understand and communicate. In all, being able to recognise symptoms and learning how to manage them will reduce the fear and lead to greater understanding and acceptance of the schizophrenic person.
References
Angermeyer, M. C., Matschinger, H. (2004) The stereotype of schizophrenia and its impact on discrimination against people with schizophrenia: results from a representative survey in Germany Schizophrenia Bulletin Vol. 30 (4) pp. 1041 – 1054
Arnold, E., Boggs, K. (1999) Interpersonal Relationships: Communication Skills for Nurses (3rd ed.) Philadelphia: WB Saunders
Arnold, E., Hallinan, K. (2000) Mind over matter Nursing Vol. 30 (10) pp. 50 – 55
Baston, S., Simms, M. (2002) Mental health nursing developing effective education in A + E Emergency Nurse Vol. 10 (2) pp. 15 – 19
Brammer, S. V. (2006) Facilitating a connection with a rehabilitation patient who has schizophrenia Rehabilitation Nursing Vol. 31 (3) pp. 92 – 94
Brinn, F. (2000) Patients with mental health illness: general nurses attitudes and expectations Nursing Standards Vol. 14 pp. 32- 36
Corrigan, P. W., Watson, A. C., Byrne, P., Davis, K. E. (2005) Mental illness stigma: problem of public health or social justice? Social Work Vol. 50 (4) pp. 365 – 369
Eisen, S. V., Dickey, B., Sederer, L. I. (2000) A self report symptom and problem rating scale to increase inpatients involvement in treatment Psychiatric Services Vol. 51 (3) pp. 349 – 353
Fisher, J. (2002) Fear and learning in mental health setting International Journal of Mental Health Nursing Vol. 11 pp. 128 – 134
Flynn, W. R. (2006) Recovery in mental illness: broadening our understanding of wellness The American Journal of Psychiatry Vol. 163 (10) pp. 1847 – 1849
Hanley, P. (2006) Reducing the stigma of mental illness: a report from a global programme of the world psychiatric association Journal of Mental Health Vol. 15 (3) pp. 377
Happell, B., Sharrock, J. (2002) Evaluating the role of a psychiatric consultation liaison nurse in the Australian general hospital Issues in Mental Health Nursing Vol. 23 pp. 43 - 60
Henderson, J. (2004) Shifting boundaries Nursing Management Vol. 11 (4) pp. 32
Janosik, E. H., Davies, J. L. (1996) Mental Health and Psychiatric Nursing (2nd ed) USA: Little, Brown and Company
Lawrence, D., Holman, C. D. J., Jablensty, A. V. (2000) Preventable Physical Illness in People with Mental Illness Perth: The University of Western Australia
Nordt, C., Rossler, W., Lauber, C. (2006) Attitudes of mental health professionals towards people with schizophrenia and major depression Schizophrenia Bulletin Vol. 32 (4) pp. 709
Philips, A. (2006) Death by discrimination Mental Health Today pp. 8 – 10
Rowden, R. (2006) 1 in 100 campaign Mental Health Nursing Vol. 26 (6) pp. 20 -22
Tay, C. S., Pariyasami, S., Ravindran, K., Ali, M. I., Rowsudeen, M. T. (2004) Nurses attitudes towards people with mental illnesses in psychiatric hospital in Singapore Journal of Psychosocial Nursing and Mental Health Services Vol. 42 (10) pp. 40 – 48
Thornicroft, G. (2006) Tackling discrimination Mental Health Today pp. 26 – 30
Vazquez, M. (2001) Providing competent care for mentally ill persons: an evidence-based goal for ambulatory care nurses Nursing Economics Vol. 19 (5) pp.228 - 234
Weller, B. F. (2005) Bailliere’s Nurses’ Dictionary for Nurses and health care workers (24th ed.) London: Elsevier
