Student nurses' perceptions of mental health care: Validation of a questionnaire

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Summary

Aim

This article describes the results of a study into the psychometric properties of a questionnaire about student nurses' perceptions of mental health care. The questionnaire was constructed in 2008, but has not yet been tested in terms of construct validity and reliability. A validated questionnaire is essential as a standardized method of analyzing student nurses' perceptions of mental health care.

Method

To investigate the construct validity, an exploratory factor analysis was performed. Reliability was determined by measuring the internal consistency of the questionnaire.

Results

A principal component analysis (PCA) yielded a two-factor solution. The first factor comprised 9 items referring to the views of student nurses on psychiatric patients; the second factor comprised 6 items referring to the views of the students about professional careers in mental health care.

Conclusion

The factor analysis and questionnaire produced two easily interpretable factors covering the same categories as those identified in the literature as determinants of a student nurse's choice for or against a career in mental health care. The questionnaire's construct validity was rated as sufficient, its reliability as acceptable. The problem is the low explained variance (25.6%). The usefulness of the questionnaire is therefore questionable. The usefulness might be improved through the expansion of some of the categories by additional items. Relevant suggestions are made in this article.

Introduction

Stigmatization of persons affected by a mental disorder is a matter of global concern (WHO, 2007). The burdens resulting from social stigma for the persons directly involved include lower self-esteem, a sense of social exclusion, and loss of income (Tsang et al., 2003). For health care providers, stigmatization and the negative perceptions of mental health care effectively operate as barriers for them to pursue a career in mental health care. This wide-spread attitude of stigmatization also precludes a large group of persons affected by a mental disorder from receiving the care they need (WHO, 2001). Studies conducted in the Netherlands confirm the generally negative perceptions that exist in relation to psychiatric disorders and mental patients, such as substance dependence, aggression, crime, and harassment (Van Schie et al., 1997, Van Weeghel, 2005).

It is also evident from research that (prospective) student nurses, both in the Netherlands and abroad, are not unsusceptible to the stigmatization of psychiatric patients. Many students have negative stereotype and unrealistic images of psychiatric patients and mental health care (Happell, 1999a, Happell, 1999b, Hoekstra et al., 2010) and these images appear to have a significant impact on the students' choice of major and, as a consequence, their choice of career (Halter, 2008, Hoekstra et al., 2010). It is a well-known fact in the Netherlands that a major in mental health care does not hold much attraction, but in other countries, too, there are but few students with a preference for mental health care as a future career prospect (Happell, 1999a, Happell, 1999b, Happell and Rushworth, 2000a, Happell and Rushworth, 2000b, Surgenor et al., 2005, DeKeyser Ganz and Kahana, 2006). In addition, stereotype images generally have an adverse effect on the quality of nursing care (WHO, 2001). This ‘Adverse effect’ is not only observed in mental health care, but also in other settings like general hospitals and nursing homes, where nurses also frequently have to deal with patients suffering from a mental disorder.

As a consequence, ensuring an adequate supply of mental health nurses may well be problematic in the future, especially if seen against the background of other recent developments in health care, such as the increase in patients suffering from multiple psychiatric disorders, the shift towards extramural care, and the aging of the population, with its inherent problems such as increased loneliness and depression (Van der Windt et al., 2008). All these developments require the availability of sufficient highly qualified mental health nurses. In the Netherlands, it is expected that it will not take long before the demand for mental health nurses outpaces supply (Van der Windt, 2008).

The problems summarized above clearly show that it is of great importance to make efforts to influence the perception of mental health care among student nurses. Conveying a realistic picture of the discipline may not only contribute to the quality of nursing care provided to psychiatric patients in the diverse settings, but could also be conducive to the choice-making process of student nurses in favor of a career in mental health care.

Not much is known about how student nurses actually perceive mental health care in the Netherlands. In 2005, Hoekstra (Hoekstra, 2006) conducted research into that question at a school of nursing in Amsterdam. To that end, she constructed a questionnaire on the basis of five categories which a literature review had shown to be relevant categories for a student's potential choice for mental health care (Hoekstra, 2006, Hoekstra et al., 2007). At the time, there were no other relevant questionnaires available and the questionnaire constructed by Hoekstra, which was entitled ‘Mental Health Care Perceptions’, was tested only in terms of its face validity. Therefore, further validation of this questionnaire was needed.

Section snippets

Aim

This article describes the results of an analysis made of the construct validity and reliability of the questionnaire ‘Mental Health Care Perceptions’ used to evaluate perceptions of mental health care among student nurses.

Design

A methodological study was conducted to test the psychometric properties of the questionnaire. To investigate the construct validity, a principal component analysis (PCA) was performed. Reliability was determined by measuring the internal consistency of the questionnaire.

Instrument

The questionnaire was constructed around five categories which had emerged from the literature as being relevant to the selection of mental health care as a student's major (Hoekstra, 2006, Hoekstra et al., 2007). The

Factor Analysis

The PCA correlation matrix showed only few coefficients of .3 or higher (7%). The KMO value was .74 and Bartlett's test of sphericity produced a statistically significant result (p < .001). These results justified the performance of a factor analysis. The PCA showed 8 factors with an eigenvalue over 1 (Kaiser's Criterion), which together explained nearly 58% of the variance (Table 1).

This 8-factor solution, however, was virtually uninterpretable, so a scree plot was created to find a more

Discussion

A factor analysis of the ‘Mental Health Care Perceptions’ questionnaire yields a 2-factor solution which explains 25.6% of the variance. The first factor concerns the students' views on psychiatric patients; the second refers to their perceptions of careers and jobs in mental health care. The question is whether these two factors represent a uni-dimensional or multi-dimensional scale. In view of their weak correlation (r = .26; P < 0.001), a multidimensional scale would seem more likely.

Of the 25

Conclusions

Despite the low explained variance (25.6%) of the 2-factor solution presented in this study for the subject questionnaire, ‘Mental Health Care Perceptions’, the factor analysis conducted yielded two easily interpretable factors covering the same categories as those identified in the literature as determinants of a student nurse's choice for or against a career in mental health care. The construct validity is expected to improve by adding some items to the list as suggested in the discussion

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