ABSTRACT
Globally, a persistent negative attitude and social rejection of people with mental illness has
prevailed throughout history in every social and religious culture. Having a mental health
problem often stimulates with it a negative attitude, and such negative attitudes towards the
mentally ill constitute great burden. This study aimed at assessing the attitude of nursing
students towards the mentally ill before and after psychiatry training experience in Federal
Neuro-psychiatric Hospital Enugu. The specific objectives were to determine: the nursing
students’ attitude towards the mentally ill before psychiatric clinical experience, the nursing
student’s attitude toward the mentally ill after psychiatric clinical experience, and ascertain
influence of socio-demographic characteristics (age, gender, type of training institution) of
nursing students’ attitude toward mentally ill before and after clinical exposure. The study
adopted the quasi- experimental design. The instrument for data collection was Community
Attitudes towards the Mentally Ill (CAMI) scales. All the 154 nursing students were enrolled
into the study owing to small sample. Data generated were analyzed using descriptive statistics,
students’t- test, one way ANOVA. Probability value less than 0.05 was considered statistically
significant. The results revealed that, majority of the respondents were in the age bracket 18-
23years, as indicated by 76 (49.4%). Regarding gender, majority 127 (82.5%) of them were
female. Nursing students’ attitude towards the mentally ill before clinical experience was
positive in both UNEC and UNTH as indicated by benevolence (2.75 ± 0.26) (2.68 ± 0.29) and
community mental health ideology (2.71 ± 0.31) (2.73± 0.31) respectively. Nursing students’
attitude towards the mentally ill after clinical experience was also positive in both UNEC and
UNTH as indicated by authoritarian (3.16 ± 0.60) (2.64 ± 0.37), benevolence (3.06 ± 0.51) (2.68
± 0.39) respectively. Type of training institution and gender had a positive influence (p<0.05) on
nursing students attitude towards the mentally ill before clinical experienceas indicated by mean
squares of 0.143. Age had a positive influence (p< 0.05) on nursing students’ attitude towards
mentally ill after clinical experience as indicated by mean squares of 0.067. H0 1 and H0 2 was
rejected (P<0.05) for both nursing students in UNEC and UNTH. H0 3 was rejected for nursing
students in UNEC (P<0.05). However, H0 3 was accepted for nursing students in UNTH. The
study then concluded that nursing students’ attitudes towards the mentally ill was positive. It was
therefore recommended that health policy makers and government should design appropriate
programmes that will assist to improve the well-being of the mentally ill.

CHAPTER ONE
INTRODUCTION
Background to the study
Globally, a persistent negative attitude and social rejection of people with mental illness has
prevailed throughout history in every social and religious culture (Luty, 2010). These negative
feelings are not only limited to mentally ill but also toward career in psychiatric/mental health
nursing. Negative feelings are prevalent even among nursing students with nursing training.
Adverse attitudes by nursing students, usually in the form of discrimination, separatism, social
distancing, and misconceptions are crucial issue not only for the mentally ill and their families,
but also for research, advocacy and policy across the world (Kapungwe, 2011).
According to Rameela (2014), people with mental illness as a whole are portrayed as violent and
dangerous people that have severely disturbed thought processes and therefore have
unpredictable behavior and should be feared and avoided. The media has facilitated this
portrayal of the mentally ill by depicting them in various distasteful ways. Horror movies about
‘psycho’ killers that have escaped from mental institutions are a prime example. The public
perceived that mental illness is related to the persons own failings, such as weakness of character
and morals, laziness, and lack of discipline and self-control (Rameela, 2014). These beliefs and
portrayals cause discrimination leading to adverse effects on employment, income, and housing
and in effect, self-esteem and self-concept (Markowitz, 2010). The negative attitude towards
people with mental illness by healthcare providers results in disparities in access, treatment, and
outcomes (Luty, 2010).
Negative attitudes such as stereotyping behaviors, social restrictiveness towards persons with
mental illness are of international concern and have negative personal and social impact on
patients and their families (Niaz, Hassan, Hussain & Saeed, 2013). The mentally ill especially
those with psychosis -schizophrenia, mood disorders such as depression, mania, and substance
abuse disorders are perceived as aggressive, violent and dangerous and not fit for coexistence in
the society. A tendency to maintain social distance from the mentally ill and to reject them
socially still persists and makes its existence felt. In order to correct misconceptions about
mental illness and raise the status of the mentally ill, psycho-educational interventions have been
used as a tool in the fight against discrimination related to mental illness by the World
Psychiatric Association (WPA) in more than 20 countries but this has not actually yielded the
expected positive outcome. Although efforts are made through psycho-education, yet public
campaigns which aim to change such views have made inconsistent impact.
There are studies on attitudes of nursing students towards the mentally ill; but the effects of
mental health training on students’ attitudes as well as the impact of clinical training in reducing
such negative attitude toward mentally ill has been inconsistent(Niaz, Hassan , Hussain &Saeed,
2013). In respect to the challenges faced by the mentally ill, ‘World Mental Health Day’ was set
up by the World Federation of Mental Health [WFMH] in 1992 to increase knowledge and
understanding of mental health issues(mental health literacy) around the world (Dinesh & Rob,
2012):). The WFMH have always make effort and continue to challenge negative attitude
towards the mentally illand promote the rights of people with mental illness. However, despite
these initiatives, many people still hold misconceptions and stereotypes about the mentally ill.
Nursing students view the mentally ill as violent, strange, unreliable, incapable and incompetent
.These notions of course have a detrimental effect on quality of life of the mentally ill in terms of
relationships, access to health care services, accommodation, education, and employment.
Factors such as gender, nature of mental illness, past experiences, and contact with the mentally
ill have been observed in some studies to affect nursing students’ attitude towards the mentally
ill (Ukpong & AbasiUbong, 2010). A study by Bayram, Kemal, Omer Gunay, Burc, Cana
&Mahmut(2011) observed that females showed a less discriminating attitude than the males.
This was based on the fact that females have been considered to be more sympathetic than males.
The researcher observed that there are fewer treatment programs for the mentally ill, both in the
institutional or community settings in Nigeria.
Consequent upon this, many of the mentally ill in need of help in our society; are now being
disowned and abandoned untreated on the streets of communities walking about naked while
those in urban cities take shelter under trees, sleep by gutters, and under the bridges. The female
ones are often abused sexually, raped and impregnated by unknown persons while some of these
mentally ill who managed to survive scavenge for food from refuse dump points. This makes
some of them prone to gastrointestinal disorders like diarrhea and dysentery. Again some of
them are exposed to road traffic accidents by moving vehicles in an attempt to cross the road
unaided with nobody assuming responsibility.
Besides the problem of poor attitude toward the mentally ill, the World Health Organization
(WHO) in 2008 also identified a global shortage of nurse psychiatrists, whereas the need for
nurse psychiatrists is growing fast (Cour des comptes, 2011). Attitude of nursing student’s is
directly related to the quality and outcome of care given to the mentally ill. It is therefore on this
background that the present study is designed to determine the attitude of university and hospital
based nursing students towards the mentally ill before and after clinical exposure/training.
Statement of Problem
Having a mental health problem often stimulates with it a negative attitude, and such negative
attitudes towards the mentally ill constitute great burden (Neeru, 2011). There is also a link
between negative attitudes toward the mentally ill and the choice of career in mental health
nursing. Although attitudes toward the mentally ill have been studied extensively among the
public worldwide; only few studies were focused onto nursing students (Happell & Gough,
2012). According to Kabir (2011), mental and behavioral disorders are common, affecting more
than 25% of all people at some time during their lives. The prevalence of mental illness in
various Nigerian communities has been reported to be as high as 27.8% and 21.3% respectively
(Wakil, Abdulmalik, Salawu, & Ahidjo, 2010). These figures imply that about one out of every
four Nigerians is at risk of developing a mental illness or mental disorder.
Reports in the literature from the United State have show that most nursing students exhibit a
negative attitude stemming largely from ignorance, and fear of the mentally ill. This poor,
negative attitude may be improved upon through proper reorientation and adequate exposure to
psychiatry during basic training. However, based on the researcher’s experience, most nursing
students even registered have been observed to develop or have mistrust and fear towards
psychiatric patients, there is also lack of interest to choose this area of specialty as the future
career by nursing students who considered people with mental illness as risky set of human
beings. It is on this premise that the researcher seeks to empirically determine the attitude of
nursing students towards the mentally ill before and after psychiatric clinical training experience.
The aim is to determine whether or not nursing students attitude towards the mentally ill will
change after training i.e. clinical experience in psychiatric hospital, or remain same despite
training or whether its gets worse even after training. There is also a paucity of research of this
nature in the nursing literature in Nigeria. This research therefore intends to fill this gap in
knowledge.
Purpose of the Study
This study aimed at assessing the attitude of nursing students towards the mentally ill before and
after psychiatry training experience.
Specific Objectives
Specifically the objectives are to:
1. determine nursing students attitude towards the mentally ill before psychiatric clinical
experience.
2. determine nursing student’s attitude towards the mentally ill after psychiatric clinical
experience.
3. Ascertain influence of socio-demographic characteristics (age, gender, type of training
institution) nursing students and their attitude toward mentally ill before and after clinical
exposure.
Research Questions
The following research questions were formulated to guide the study:
1. What is nursing students’ attitude towards the mentally ill before psychiatric clinical
experience?
2. What is nursing students’ attitude towards the mentally ill after psychiatric clinical
experience?
3. What are influence of socio-demographic characteristics (age, gender, type of training
institution) on nursing students’ attitude toward mentally ill before and after clinical
exposure?
Hypotheses
1. There is no significant difference in the attitude of nursing students towards the mentally
ill before and after psychiatric training experience.
2. There is no significant difference in the attitude of male and female nursing students’
towards the mentally ill before and after psychiatric training experience.
3. There is no significant difference in the attitude of nursing students’ towards the mentally
ill before and after clinical experience in respect to training institution.
Significance of the Study
The study will reveal the attitude of nursing students towards the mentally ill before and after
exposure to psychiatric clinical experience. Findings of the study will also reveal whether or not
there is difference in the attitude of students before and after exposure to psychiatric clinical
exposure. The findings of the study will give insights regarding attitude that affects the mentally
ill. This will be helpful in designing appropriate training or seminars on attitude change for the
general public and the health professionals’ in Nigeria and other parts of the world about mental
illnesses.
The community results of the study will make the health institutions to identify interventions to
combat any prejudice in the communities. Thus make them to be more receptive, and have a
positive attitude towards mentally ill.
The mentally ill and significant others, outcome of this study will reduce negative attitude
from both public and health professionals; promote the rights of people with mental illness and
enable the mentally to enjoy freedom, dignity, acceptability in the public and quality care from
the health providers.
The policy makers, outcome of this study will enable key players’ in health sector and policy
makers to design health policies that will affect the mentally ill positively. Create an
environment that is mentally friendly. This will help the public to treat mentally ill with utmost
respect and dignity. Hence, reduces the problem of discrimination and dehumanization of the
mentally ill.
The profession, findings of the study on nursing students’ attitude toward the mentally ill will
give students correct cues regarding mental illness. This will enable nursing students to support
advocacy programme that favour mentally ill; stimulates students to sponsor polices and
encourages those students to give quality care to the mentally ill without any form prejudice.
Again result of the study will enable nursing students to have a better understanding about
concept of psychiatry mental health nursing. This will in turn correct misconceptions and
motivate students to pursue their career in psychiatry nursing course.
The research and the researcher: future researchers’ will find data generated from the study
very useful, as they could build on the findings in furthering researches in this area of
knowledge.This study will contribute to the literary world.
Scope of the study
This study is delimited to nursing students. Students who have enrolled for post basic psychiatry
nursing training programme will be excluded from the study.
Operational Definition of Terms
For the purpose of this study, the following concepts were defined operationally:
Attitude refers to certain perceptions or beliefs held by nursing students towards the mentally ill.
The mentally ill is a person who owing to mental illness requires care, treatment or control for
his own good or in the public interest, and is for the time being incapable of managing himself or
his affairs and are managed by the nursing students.
Attitude towards the mentally ill refers to certain positive/negative perceptions or beliefs held
by nursing students towards a person with mental illness who requires care, treatment or control
for his own good or in the public interest.
Psychiatric/ mental health nursing is an area of nursing specialty that cares for people of all
ages with mental illness or mental disorders, that is choosing as a career by nursing students after
obtaining their basic nursing training certificate or pursue as a postgraduate degree.
Nursing students are group of students undergoing nursing training either in the department of
nursing sciences in university or on hospital based training in schools of nursing which have
certain beliefs and perceptions towards people with mental illness.