MENTAL HANDICAP VOL. 12 MARCH 1984

Other 10 Not given 5

STUDENT NURSES‘ PERCEPTIONS OF

8 4

WORKING IN MENTAL HANDICAP SERVICES

Frequency of contacts per cent

John McEvoy

(n)

This article reports on a survey of student nurses in mental handicap: their reasons for entering training; the qualities they feel are necessary for nursing mentally handicapped people; the aspects of work they enjoy most; the problems they encounter; and their hopes for the future.

37 31 19 6 6

Introduction Moores and Grant (1976) have suggested that institutions for

mentally handicapped people tend to attract or retain staff whose attitudes are in accord with those prevailing in them. And studies have reported staff preferences for working with particular groups of mentally handicapped people (Jensema and Shears, 1971; Harris, 1965). Moreover, there can be widespread differences in attitudes between institutions (Butterfield, Barnett and Bensberg, 1968). Studies of staff attitudes to disability are vital as the development of newly emerging patterns of service is highly dependent upon the attitudes of the various professional groups within the service organisations.

An important issue, which has received scant attention to date, is why staff choose to work within mental handicap services in the first place.

In the Republic of Ireland, the largest group among the many professions caring for and educating mentally handicapped people are Registered Nurses in Mental Handicap (RNMH’s). It was not until 1960 that the first RNMH was registered. By 1979, however, a revised syllabus of training had been introduced and there were approximately 975 nurses and 470 student nurses employed by voluntary agencies providing services for mentally handicapped people (Working Party on General Nursing, 1980). The purpose of the present study was to ascertain the possible influences affecting career choice of student nurses entering mental handicap services and students’ attitudes to aspects of their work.

Students’ characteristics Of the nine nurse training schools attached to the mental

handicap services in the Republic of Ireland, two participated in the study, yielding a one in five sample and a total of 81 students surveyed. 32 per cent were in their first year of training; 30 per cent in their second year; 37 per cent in their third year. Ages ranged from 18 to 33 years (mean 20.8 years). The majority of students were Irish (98 per cent), female (91 per cent), and single (% per cent).

Socio-economic groupings, based on fathers’ occupation, were classified accordmg to the Census of Population of Ireland (1979). 38 per cent were in the farmers/professional/ management group; 30 per cent in the non-manual, self- employed group; 24 per cent in the manual group; 4 per cent

30 25 15 5 5 JOHN McEVOY is a Research Officer at St.

Michael’s House, Dublin.

retired; and 5 per cent not given. 79 per cent of students had attended a local secondary school;

11 per cent private or fee-paying schools. 77 per cent had attended a pre-nurse training course, or had engaged in hospital work prior to entering a school of nursing.

Career influences

REASONS FOR STARTING TRAINING. Information was obtained by means of a questionnaire. Students were invited to state their main reasons for wanting to become an RNMH (see Table 1). The most common influence was previous contact with mentally handicapped people. Many students were interested in working with people and wanted a challenging career. Interestingly, few had wished to be nurses.

In addition students rated, on a three-point scale, a series of statements describing possible influences or reasons for entering nurse training. The five items felt to be of “very great importance” were: “felt nursing mentally handicapped people would be rewarding work for me” (78 per cent); “wanted to work with people” (73 per cent); “wanted to work with children” (67 per cent); “past experience with mentally handicapped people through voluntary work” (61 per cent); and “felt I could help mentally handicapped people to be more independent” (57 per cent).

PRECOURSE CONTACT. The most common forms of contact were through: friends or relatives with a mentally

TABLE 1: Reasons for entering nurse training ~~~~ ~

Reason

Previous contact with mentally handicapped people Wanted challenging rewarding career Interested in working with people Wanted to help less fortunateiunderprivileged Wanted to work with children Wanted to be a nurse Wanted to help mentally handicapped people reach their Dotential

per cent

31 14 12 9 7 6 6

TABLE 2: Frequency of contact with mentally handicapped people prior to entering nurse training

Quite a lot Occasionally Often Seldom Never

12 @ 1984 British Institute of Mental Handicap

MENTAL HANDICAP VOL. 12 MARCH 1984

handicapped person in their family (34 per cent); voluntary work (32 per cent); and work experience within mental handicap centres (29 per cent). Five per cent had met handicapped people through school visits.

Table 2 shows students’ frequency of contact with mentally handicapped persons prior to entering nurse training. 66 per cent could be described as having a good deal of contact before

PERSONAL QUALITIES. Students felt “patience and tolerance” (53 per cent) and “understanding of mentally handicapped people” (19 per cent) were the most important qualities needed: “Understanding mentally handicapped people” was viewed a most necessary quality by third year students (X2 = 30.6, df 15, p < 0.01). VALUED EXPERIENCES. “Helping mentally handicapped people to develop and reach their potential” was reported to be the most enjoyable aspect of work (35 per cent). However, “personal satisfaction and reward from the job” (31 per cent) and “developing relationships with handicapped people” (28 per cent) were also frequently mentioned. PERCEIVED DIFFICULTIES. 86 per cent of students reported difficulties or problems with their work including: staffhesident ratio (22 per cent); dealing with aggressive or disturbed behaviour (20 per cent); staff relations (14 per cent); and “lack of community involvement” (1 1 per cent). 33 per cent reported a wide variety of difficulties, including lack of finance for services, and general work pressures. THE FUTURE. 70 per cent of students intended to remain nursing within mental handicap services; 5 per cent intended to gain further experience but return to mental handicap services later in their career; 5 per cent planned to remain in mental handicap services for a short while, then leave; 10 per cent intended to leave on graduation; and 10 per cent were undecided.

Of the students intending to leave, 47 per cent wished to enter general nursing, 23 per cent psychiatric nursing, and 30 per cent other forms of employment. 27 per cent of those intending to remain in mental handicap stated that they would prefer to work within day care services. 27 per cent wanted to work with severely handicapped people; 17 per cent in communityhostel settings; and 29 per cent in a variety of other settings. 83 per cent of students wished to see changes within services. 36 per cent asked for “more public education about mental handicap”, 19 per cent wished to “see greater hostel development”, and 15 per cent wished to see “more skilled staff within centres”. The remaining 30 per cent mentioned a number of changes ranging from “the development of community nursing” to “increased parental involvement in services”.

Discussion Over half the students surveyed had a high degree of contact

with mentally handicapped persons prior to entering the school of nursing, mainly through relatives or friends with a mentally handicapped person in their family, and voluntary work. This contrasts sharply with a recent national survey of young people’s perceptions of mental handicap (McConkey, McCormack and Naughton, 1983) in which only 25 per cent of the young people surveyed had ever had contact with a mentally handicapped adult, nearly 50 per cent had never been in their company, and only 28 per cent showed interest in working in mental handicap services.

It is possible that the nursing schools in the present study may have included previous contact or experience with mentally handicapped people in their admission requirements. Should recruitment of staff for work in mental handicap services require such experience as a prerequisite? There is growing evidence that certain forms of contact may simply serve to reinforce existing stereotypes (Siller, 1976). The issue is worthy of further study.

Among the problems encountered by the students were: staff to resident ratio; dealing with aggressive behaviours; and staff

training.

relations. The challenge for nurse educators is to incorporate into training schemes methods and techniques which will help students cope with service problems.

The ratio of staff to client in group settings is frequently discussed. However the assumption, that the more staff available, the more time devoted to direct interaction, is unfounded (Moores and Grant, 1976; Felce, Mansell, and Kushlick, 1980; Mansell, Felce, Jenkins, and DeKock, 1982). The introduction of “room management” procedures, as described by Porterfield, Blunden, and Blewitt (1980), is an example of a technique which may help students to understand and cope with service problems.

Contrary to previous studies (Harris, 1%5), students saw their role as one of developing relationships with mentally handicapped people and helping them to realise their potential; this illustrates an awareness of the need for training and educating mentally handicapped people rather than simply caring for them (Stokes, 1979). While the majority of students wished to continue working with mentally handicapped people after graduation, many wanted to work in day care or community settings. Students’ awareness of the need to develop community facilities is encouraging, and interesting given that both nurse training schools surveyed were attached to large residential centres.

Care must be taken in interpreting the results as unique local factors may have influenced the attitudes expressed and the validity of responses is a major difficulty. Do students’ responses accurately reflect their original reasons for entering training? If students’ responses to the open-ended question are examined in conjunction with their responses to the checklist of possible reasons for entering training, there is a strong suggestion that contact with mentally handicapped people is an influence in deciding to work in the mental handicap services.

Despite the limitations the present study has been encouraging and informative. Students are positively committed to working with mentally handicapped people and to helping them realise their potential. The challenge for services is to harness and exploit the potential of their staff.

Acknowledgements Grateful thanks are extended to John Saunders and K. Maria

Neary for their cooperation and assistance during the study. Thanks are also due to Dr. Roy McConkey and Bob McCormack for their useful comments and advice.

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@ 1984 British Institute of Mental Handicap 13