Hui-Ping Wang,Chang-De Jin

1Graduate College,Tianjin University of Traditional Chinese Medicine,Tianjin,China;2School of Nursing,Tianjin University Traditional Chinese Medicine,Tianjin,China.

Abstract Objective:To explore the relationship between mental nurses' discrimination against mental patients and the cognitive level of ethical atmosphere.Methods:Convenience sampling was adopted,147 psychiatric nurses from two psychiatric hospitals in guangdong province were selected as research subjects from march to May 2019.A discrimination against mental patients scale (DAMPS) and a ethical Climate Questionnaire (ECQ) were investigated.Results:The total score of ECQ was (87.33 ± 10.99);the score of DAMPS was (1.94 ± 0.60).The cognitive level of ethical atmosphere of psychiatric nurses was negatively correlated with the attitude of discriminating against psychopaths;Gender,marital status,department category,whether they are psychiatric nurses,whether they accept ethical knowledge,and the cognitive level of ethical atmosphere are the influencing factors of the attitude of psychiatric nurses to discriminate against psychiatric patients (R2=0.476, P ＜0.05).Conclusion:There was a negative correlation between the ethical cognition level of psychiatric nurses and the attitude of discriminating against psychopaths.Hospitals should pay attention to the improvement of the ethical atmosphere of psychiatric nurses and strengthen their ethical education.

Keyword:Psychiatry,Nurse,Discriminatory psychosis attitude,Ethical atmosphere cognition.

Background

Psychiatry has always been in a lower position in the medical field than other disciplines [1].At the same time,mental patients are suffering from the secular discrimination [2].As the most direct contact with patients,psychiatric nurses' attitude towards patients with mental illness has an important impact on the treatment and rehabilitation of patients [3].Therefore,the research on the discriminatory attitude of psychiatric nurses is beneficial to improve the occurrence of the adverse event of discrimination [4].At present,studies at home and abroad have found that the ethical atmosphere in hospitals affects the attitude and way of nurses towards ethical issues [5].The attitude and way of treating ethical issues has a certain impact on whether there is discrimination [6].Therefore,this study explored the relationship between the cognitive level of ethical atmosphere for psychiatric nurses and the attitude of discriminating against mental patients.

Methods

Participants

From March 2018 to May 2019,150 psychiatric nurses were selected from 2 psychiatric hospitals in hebei province by convenience sampling method.A total of 150 questionnaires were distributed by the two hospitals,with an effective recovery rate of 98%.

Inclusion and exclusion criteria

Inclusion criteria:①Registered psychiatric nurse;②Working years in psychiatric department ≥1 year;③Informed consent and voluntary participation in this study;Exclusion criteria:Participants were unable to participate during the investigation.

Instruments

General information questionnaire:It is compiled by the investigator based on the literature and expert communication.It included academic qualifications,professional titles,positions,marital,years of work,whether to voluntarily choose psychiatric care,whether to be a psychiatric specialist nurse,or whether to accept ethics training.

Ethical Climate Questionnaire (ECQ):The source scale was compiled by Victronn et al[7]in 1988 and is mainly used to measure the ethical awareness of medical staff.The Cronbach's coefficient of the scale is 0.6 to 0.8.Bian[8]was translated into Chinese in 2006 and used to evaluate the ethical atmosphere of medical staff.The Cronbach's coefficient of the Chinese scale in the study was 0.65-0.86.The scale includes 5 dimensions with a total of 24 items:legal and normative (7 items),caring (6 items),utilitarian (5 items),independent judgment (3 items) and rule (3 items).It is a 5-point Likert scale ranging from 1(very disagree) to 5 (very agree).The total score is from 24 to 120.The higher the score,the better the nurse's awareness of the ethical atmosphere of the hospital.In this study,the Cronbach's coefficient for each dimension of the scale was from 0.63 to 0.88,and the total Cronbach's coefficient of the scale was 0.87.

Discrimination against mental patients scale(DAMPS):The scale was compiled by Zeng Q Z et al.[9] in 2009 based on China's national conditions to assess the attitude of public discriminatory mental illness patients.The scale is a 5-point Likert scale ranging from 0(very disagree)to 4(very agree).

Data collection methods

The investigator explained the purpose of the survey to the psychiatric nurses,and provided the questionnaire after obtaining their consent.Psychiatric nurses filled in the free time online.All questions must be filled out to avoid the missing data.

Statistical analysis

Data analysis was conducted with SPSS 21.0 software.The variables following normal distribution are expressed as mean ± standard deviation (SD).The frequency and percentage for counting data are expressed.Pearson correlation analysis was used to analyze the relationship between cognitive level of ethical atmosphere and attitude of discriminating psychopaths.

Results

Demographic characteristic

The majority of the research subjects are women(82.3%).The working year of psychiatric department was (7.13 ± 4.98) years.About 68.7% have bachelor's degree (101 nurses),about 42.2% were primary nurse,70.1% Married couples (103 nurses).The wards were mainly closed wards (113 nurses),accounting for 76.9%.Mainly non-psychiatric nurses (118 nurses)accounted for 80.3%.Most of them did not receive ethics education and training (103 nurses),accounting for 70.1%.

Scores of cognitive level of ethical atmosphere and attitude of discrimination against mental patients

In this survey,the total score of ethical atmosphere cognition of psychiatric nurses was (87.33 ± 10.99).The attitude score of psychiatric nurses discriminating against mental patients was(1.94±0.60).

One-way anova of psychiatric nurses' attitude toward discrimination against mental patients

Using the general data questionnaire as an independent variable,a one-way analysis of variance was conducted with psychiatric nurses discriminating the psychology patient's attitude dependent variable.The results showed that gender,marital status,departmental category,whether it was a psychiatric specialist nurse,whether to receive ethical knowledge training,the difference in the total scores of psychotropic nurses discriminating mental patients(P＜0.05)in Table 1.

Correlation analysis of cognitive level of ethical atmosphere of psychiatric nurses and attitude score of discriminating psychopaths

By Pearson correlation analysis,there was a negative correlation between the cognitive level of ethical atmosphere of psychiatric nurses and the attitude of discriminating against mental patients(P＜0.05) in Table 2.

Multiple linear regression analysis of psychiatric nurses' attitudes toward discriminating mental patients

There are 6 variables (Gender,marital status,department category,whether they are psychiatric nurses,whether they accept ethical knowledge,and the cognitive level of ethical atmosphere) in the multiple linear regression analysis with psychiatric nurses dependent variable.Variables that did not achieve significant effect were excluded.The results showed that the adjustment coefficient R2was 0.476,and six variables accounted for 47.6% of the total variation of the sense of belonging of nursing students in clinical practice.

Discussion

Organizational ethical atmosphere refers to the process of employees' perception of organizational attitudes and solutions to ethical behaviors and ethical problems as well as their own cognition of ethical environment[5].This study found that the total score of ethical atmosphere cognition of psychiatric nurses was (87.33± 10.99),which was in the middle level.This is generally consistent with the research of Li Q F [10].At present,the development of ethics education in China is relatively slow.School ethics education has not attracted attention,although relevant content courses are offered,they are not taken seriously[11-12].In addition,after nurses enter the hospital,the ethics training in hospitals is relatively weak,and evensome hospitals do not include ethical issues in the training courses [11-12],which further aggravated the problem that the ethical awareness of psychiatric nurses was not high.

Table 1.Comparison of Attitude Scores of Psychiatric Patients with Different Social Demographic Discrimination

Table 2:Pearson Correlation Analysis of Nurses' Ethical Atmosphere Cognition Level and Discrimination of Psychiatric Patients'Attitude Scores

The attitude of discriminating against mental patients refers to the negative views and practices of discriminating and belittling mental patients.In this study,the average total attitude score of psychiatric nurses discriminating against mental patients was(1.94± 0.60),which was lower than the norm (2.07 ± 0.65)[13].The reason for the analysis may be that psychiatric nurses have frequent contact with patients and have a good knowledge of mental illness,so they can understand mental patients more.Therefore,discriminate against mental patients more than others.

The results showed a negative correlation between the level of ethical cognition and the attitude of discriminating mental patients.The higher the level of cognition of the ethical atmosphere of psychiatric nurses,the lower the attitude scores of discriminating mental patients.According to the theory of knowledge and belief,we can know that knowledge is the basis of changing attitudes [14].Therefore,we should strengthen the ethical knowledge of psychiatric nurses,so as to improve their ethical awareness and further improve the attitude of discriminating mental patients.

The results of this study show that the cognitive level of psychiatric nurses' ethical atmosphere is closely related to the attitudes of discriminating mental patients,and the ethical atmosphere cognition level is an important factor influencing the attitude of patients with mental illness.Therefore,hospitals should pay attention to the improvement of the ethical atmosphere of psychiatric nurses and strengthen their ethical education,thereby further improving or even eliminating the attitude of psychiatric nurses discriminating against mental patients and promoting the development and progress of psychiatric nursing and health care.