Mental Health Nurses’ Measured Attitudes To People And Practice: Systematic Review of UK Empirical Research 2000-2019

Introduction
Attitudes are considered integral to mental health nursing practice.

Aims
To comprehensively describe the i) measured attitudes of UK mental health nurses towards people and practice; ii) effectiveness of interventions to change attitudes; and iii) relationships between their attitudes, other variables/constructs, and practice.

Methods
Using systematic review methodology, multiple databases (CINAHL, Scopus, PsycINFO, Web of Science Core Collection, Google Scholar) were searched. Eligible studies involved measurement of UK-based mental health nurses’ attitudes with multi-item scales. Studies were quality appraised, mean (SD) attitudinal data were standardised, and other results converted to standardised effect sizes.

Results
N=42 studies were included. Negatively appraised attitudinal targets were people with a borderline personality disorder diagnosis, substance misuse, and acute mental health presentations. Educational interventions were associated with immediate increases in positive appraisals but sustainability was poorly evidenced. There was very limited study of attitude-practice links.

Discussion
This review identifies priority attitudinal targets for action but also demonstrates that future work must consider the interconnectedness of attitudes and their relationship with practice.

Implications for Practice
Priority areas for consideration are attitudes to borderline personality disorder, substance misuse and mental health co-morbidity. Addressing disparities between nurses’ attitudes and those of service users is important. More robust research is required into the effectiveness of interventions to change attitudes and into attitude-practice links.