Determining the attitude, knowledge and practice of pediatric nurses in recognizing signs of mental health problems in children Ms. Rebecca Johnson, RN MScN Paediatric Nurse Practitioner Clinical Nurse Specialist
Aim of the Study: To enhance the knowledge and practice among nurses in the pediatric unit in the Princess Margaret Hospital in recognizing signs of mental health problems in children.
Purpose of the study To strengthen and enhance the healthcare services provided for the children and their families in The Bahamas.
Problem statements There is growing evidence to suggest that mental health problems are prevalent among children (National Mental Health Association, 2005). Mental health problems in children often go undetected (Friedman 2006).
Definitions Mental health can be considered as being on a continuum Complete mental wellness emotional and behavioral problems mental distress mental disorders mental illness severe debilitating mental illness When children live full creative and sociable lives, making the most of their opportunities, and can cope with difficulties and frustrations they are mentally healthy (Young Minds 2002 in Honeyman 2007).
Rationale Nurses in pediatric units are in an opportune position to observe, report and refer signs of possible mental health problems in children and so that these children can receive intervention at an early stage.
3. What are the barriers and facilitators that impact the practice of nurses in the pediatric unit when caring for children with mental health problems? Research questions 1. What is the attitude of nurses in the pediatric unit towards caring for children with mental health problems? 2. Are nurses in the pediatric unit able to recognize mental health problems in children?
Sample size The sample size was chosen to ensure a confidence level of 95% and a confidence interval of 5% Twenty-nine (29) Registered Nurses and twentyseven (27) Trained Clinical Nurses for a total of fifty-six (56) persons. The sample size of forty-five (45) that was used in this research can be considered as adequate. Krejcie& Morgan (1970)
Exclusion Criteria - Nurses who are on extended study leave or extended sick leave during the study period. Sampling techniques The sample was randomized by using a data base listing of the nurses who are working in the pediatric department. Inclusion Criteria - Registered Nurses and Trained Clinical Nurses practicing within the Pediatric Ward in PMH February 1 st 2014 February28 th, 2014.
Research Tool Permission for the study was obtained from the Ethics Committee and the Executive Management Committee of the Princess Margaret Hospital An Action Research design was used for this study The research tool was developed by this researcher Research tool information was based on the literature review on mental health problems in children
Methodology The research tool which consists of biographical data and the pre/post test was completed and placed by the participant in a sealed box to ensure anonymity. The participants questionnaires was randomly assigned a label such as N-1 to N45, which was used throughout the pre and post tests to provide for more efficient and meaningful analysis.
Methodology The participants then participated in an intervention in the form of two educational sessions, where information on mental health problems in children was provided. These sessions were conducted by a Psychiatric Child and Adolescent Health Nurse Practitioner. The participants were then asked to complete the post test immediately after the session.
Demographic statistics Age Frequency Percent Valid Percent Cumulative Percent 20-30 yrs 6 13.3 13.3 13.3 Valid 30-40 yrs 8 17.8 17.8 31.1 > 40 yrs 31 68.9 68.9 100.0 Total 45 100.0 100.0
Demographic statistics Years of Experience in Nursing Frequency Percent Valid Percent Cumulative Percent 0-5 yrs 5 11.1 11.1 11.1 6-10 yrs 6 13.3 13.3 24.4 11-15 yrs 6 13.3 13.3 37.8 Valid 16-20 yrs 7 15.6 15.6 53.3 21-30 yrs 7 15.6 15.6 68.9 >30 yrs 14 31.1 31.1 100.0 Total 45 100.0 100.0
Demographic statistics Category of Healthcare Professional Frequency Percent Valid Percent Cumulative Percent NO 5 11.1 11.1 11.1 Valid RN 19 42.2 42.2 53.3 TCN 21 46.7 46.7 100.0 Total 45 100.0 100.0
Demographic statistics Length of time in Pediatrics Frequency Percent Valid Percent Cumulative Percent < one yr 4 8.9 8.9 8.9 1-3 yrs 10 22.2 22.2 31.1 4-6 yrs 8 17.8 17.8 48.9 Valid 7-10 yrs 9 20.0 20.0 68.9 11-15 yrs 4 8.9 8.9 77.8 16-20 yrs 2 4.4 4.4 82.2 > 20 yrs 8 17.8 17.8 100.0 Total 45 100.0 100.0
Demographic statistics Highest Professional Qualification Frequency Percent Valid Percent Cumulative Percent Cert-TCN 21 46.7 46.7 46.7 Diploma- RN 8 17.8 17.8 64.4 Valid ASc- Nursing 10 22.2 22.2 86.7 BScN 6 13.3 13.3 100.0 Total 45 100.0 100.0
Community The Intervention Factors that impact the mental health of a child Developmental age Environment Frequency Genetics Duration Home School Intensity
Lesson learnt COLLABORATION Nurses and other Healthcare Providers must aspire to grow beyond clutching their cherish professional treasures and clinical talents and learn the art of true collaboration Johnson (2014)
Results of study Changes in eating habits * Changes in eating habits Crosstabulation Changes in eating habits Total False True Changes in eating habits Total False True Count 4 5 9 % within Changes in 44.4% 55.6% 100.0% eating habits % within Changes in eating habits 23.5% 17.9% 20.0% % of Total 8.9% 11.1% 20.0% Count 13 23 36 % within Changes in 36.1% 63.9% 100.0% eating habits % within Changes in eating habits 76.5% 82.1% 80.0% % of Total 28.9% 51.1% 80.0% Count 17 28 45 % within Changes in 37.8% 62.2% 100.0% eating habits % within Changes in eating habits 100.0% 100.0% 100.0%
Results of study Changes in sleeping habits * Changes in sleeping habits Crosstabulation Changes in sleeping habits Total False True Changes in sleeping habits Total False True Count 4 4 8 % within Changes in 50.0% 50.0% 100.0% sleeping habits % within Changes in sleeping habits 30.8% 12.5% 17.8% % of Total 8.9% 8.9% 17.8% Count 9 28 37 % within Changes in 24.3% 75.7% 100.0% sleeping habits % within Changes in sleeping habits 69.2% 87.5% 82.2% % of Total 20.0% 62.2% 82.2% Count 13 32 45 % within Changes in 28.9% 71.1% 100.0% sleeping habits % within Changes in sleeping habits 100.0% 100.0% 100.0%
Pre/Post Test A. The following may be signs of mental health problems in children # change from False to True % change from False to True 1. Changes is sleeping habits 9 24.3% 2. Changes in eating habits 13 36.1% 3. Poor school performance 11 28.2% 4. Changes in personality 12 26.7% 5. Use of tobacco or alcohol 10 37% 6. Stealing 7 25.9% 7. Fighting 7 22.6% 8. Does not want to go to school 10 34.5% 9. Does not like playing with other children 11 29.4%
A. The following may be signs of mental health problems in children Pre/Post Test Pre/Test Pre/Test Post- Test Post -Test True False True False 1. Changes is sleeping habits 37 8 32 13 2. Changes in eating habits 36 9 28 17 3. Poor school performance 39 6 31 14 4. Changes in personality 45 0 33 12 5. Use of tobacco or alcohol 27 18 27 18 6. Stealing 27 18 28 17 7. Fighting 31 14 29 16 8. Does not want to go to school 29 16 26 19 9. Does not like playing with other children 34 11 28 17
Pre/Post Test A. Risk Factors for mental health problems in children # change from False to True % change from False to True 11. Chronic illness 7 28% 12. Child abuse 5 13.9% 13. Low self esteem 5 13.2% 14. Dysfunctional and unstable family environment 4 11.4% 15. Community violence 5 17.9% 16. Learning disorder 13 39.4% 17. Poverty 8 40% 18. Parental unemployment 7 43.8% 19. Parental illiteracy 11 52.4% 20. Single parent homes 7 63.6%
Pre/Post Test A. Risk Factors for mental health Pre/Test Pre/Test Post-/Test Post /Test problems in children True False True False 11. Chronic illness 25 20 29 16 12. Child abuse 36 9 40 5 13. Low self esteem 38 7 38 7 14. Dysfunctional and unstable family environment 35 10 41 4 15. Community violence 28 17 31 14 16. Learning disorder 33 12 24 21 17. Poverty 20 25 17 28 18. Parental unemployment 16 29 18 27 19. Parental illiteracy 21 24 20 25
in children Nurses Attitude & Perception Pre-Test A. The following statements reflects your personal opinion on the issue True False 21. I have received training related to mental health problems in children 22. I am confident about caring for children with mental health problem 23. Children with mental health problems should not be cared for in the pediatric unit 24. My work load is too heavy to cope with caring for 22 23 31 14 21 24 13 32 children with mental health problems 25. I am able to recognize signs of mental health problems 41 4
in children Nurses Attitude & Perception Post-Test A. The following statements reflects your personal opinion on the issue True False 21. I have received training related to mental health problems in children 22. I am confident about caring for children with mental health problem 23. Children with mental health problems should not be cared for in the pediatric unit 24. My work load is too heavy to cope with caring for 34 11 40 5 15 29 12 33 children with mental health problems 25. I am able to recognize signs of mental health problems 42 3
Significance of the study Contributes to the body of knowledge in the area of research and nursing education Will result in the design of a mental health awareness checklist which can used by health professionals who provide care for the pediatric population in The Bahamas Will potentially enhance the quality of life for children and their families in The Bahamas
Journey to Action
Undetected and untreated mental health problems in children can have lifelong devastating effects. Tagged for Action Nurses will hopefully be inspired to improve services for children with mental health problems in all care settings (Honeyman 2007). You are Next!!
Reference Reid-Searl, K., Dwyer, T., Happell, B., Moxham, L., Kahl, J., Morris, J., Wheatland, N.(2009). Caring for children with complex emotional and psychological disorders: experiences of nurses in a rural paediatric unit Journal of Clinical Nursing, 18, 3441 3449 Rydon, S. E.( 2005).The attitudes, knowledge and skills needed in mental health nurses: The perspective of users of mental health services International Journal of Mental Health Nursing (2005) 14, 78 87. Zubrick, S. R., Silburn, S. R., Burton, B., Blair, E.(2000). Mental health disorders in children and young people: scope, cause and prevention. Australian and New Zealand Journal of Psychiatry; 34:570 578.
Reference Honeyman, C. (2007). Recognising mental health problems in children and young people. Paediatric Nursing. 19, 8,38-44. Pryjmachuk, S., Graham, T., Haddad, M., Tylee, A.(2011). School nurses perspectives on managing mental health problems in children and young people. Journal of Clinical Nursing, 21, 850 859. Ravens-Sieberer, U. (2008).The contribution of the BELLA study in filling the gap of knowledge on mental health and well-being in children and adolescents in Germany. European Child Adolescent Psychiatry, 17:5 9.
Acknowledgements The Ethics Committee of the Public Hospitals Authority, Nassau Bahamas The Executive Management Committee of the Princess Margaret Hospital, Nassau Bahamas. Mrs. Marleen Martinborough, Psychiatric Child and Adolescent Health Nurse Practitioner; Nursing Officer I at the Sandilands Rehabilitation Centre, New Providence Bahamas The Nursing and Support Staff of the Pediatric Department (Children s Ward) Princess Margaret Hospital Ms. Paulette Cash and Dr. Anthony Frankson of the PHA Research Committee THANK YOU QUESTIONS/COMMENTS