Research article review


There are variousfactors that affect nurses’ behavior while performing their roles.Among the factors are attitude, practices and training of nurses(Cherry, B., &amp Jacob, S. R. 2016). Like other people, nurses toohave both negative and positive attitudes to a wide range of issues.Since attitudes can influence the nurses’ behaviors, they may alsohave an impact on the provision of healthcare services. However,nurses are recommended to do away with their personal views andembrace practices and training that improve the ability to addresstheir professional duties. Therefore, there is a need for exploringthese factors to determine their relationships and predictors. Thispaper reviews the study conducted by Robson et al. (2013).

Research aim and question

The researchthat was conducted by Robson et al. (2013) aimed at examiningthe attitudes, confidence, clinical practice and perceived need fortraining in registered mental health nurses with regard to thephysical health care of patients with severe mental problems. Theresearch question of this study was: Do nurses with additionalqualification, physical health care training, and based in-patientrather than community setting have more positive attitudes andgreater confidence while attending to the mentally ill patients?

Study design

The studyemployed a cross-sectional research design. This research method isan observational method that is used to investigate the prevalence ofspecific attributes in a given population at a particular point oftime (Glasper &amp Rees, 2017). Robson et al. (2013) used thedesign to determine the attitude and confidence among mental healthnurses. As in the case of this study, cross-sectional surveys usequestionnaires. Through this design, the researchers could be able toprovide insights on the overall picture of attitude and confidence ofmental health nurses towards physical healthcare. The investigationinvolved secondary analysis of cross-sectional data. Chi-square andt-tests were employed to determine the relationships betweenparticipant variables. The relationship between attitudes andpractice was studied using multiple regression analysis.

Sample selection

The investigatorsrecruited a convenient sample of 585 approved mental health nursesfrom the National Health Service Mental Health Trust in the UnitedKingdom. 62% of the participants were female, and 70% worked asin-patient nurses. The sample was not representative of the nursepopulation in the UK since it did not employ a random selection ofparticipants. Random technique produces a representative sample sinceit gives equal opportunity to all members of the nurse population ofbeing selected. Since the sample was not representative, thereliability of the result obtained in the study may be relativelylow. Stausberg M. &amp Engler S. (2013), argue that in order for astudy to yield valid and reliable results, the sample should be arepresentative of the target population.

Data collection

Robson et al.(2013) used data collected from 2006 to 2007. Survey forms had uniquecodes to differentiate non-responders from responders. Theresearchers employed evidence-based techniques to optimize theresponse rate. The instrument for the cross-sectional survey was astandardized anonymized questionnaire. The questionnaire was composedof Physical Health Attitude Scales for mental health nurses (PHASe)and developed questions to collect demographic, clinical, practiceand training data. The PHASe comprised of 28 item questionnaire thatwas divided into four subclasses: confidence, perceived barriers tophysical health, and attitude of nurses towards smoking. The itemshad scores of 1 to 5. Data about nurses’ involvement in general andparticular tasks of physical healthcare and perceptions on the needfor training were also collected. Ethical considerations during thestudy include voluntary participation and confidentiality.


There was 52%response rate. The nurses were involved in providing primary care,dietary and exercise advice. 50% of the participants involved insupporting patients to cease smoking while less than half engagedgiving contraceptive counseling and eyesight checkup. The nursesgenerally had a positive attitude towards their role in healthpromoting activities. Most of the respondents were confident intechnical skills while a minor percentage perceives that theirworkload and client’s motivation were setbacks to providingeffective physical healthcare. Most of the nurses supported stoppingsmoking among patients. Approximately 25% hold that smoking togetherwith patients enhances the patient-nurse relationship.

Training of nurses prior to or post-registered training wasassociated with more positive attitudes towards physical healthcareservice delivery to the mentally ill. 80% and 69% reported that theyneed training for effective management of various health issues andto aid discussions on smoking respectively. However, the attitudes ofthe participants vary according to their smoking status. Nurses whodid not smoke were positive towards smoking-cessation programs thanthe smokers. Robson et al. (2013) found the predictors ofphysical healthcare practice to be demographic characteristics,attitude, work grade, work setting, and training (last 5 years).These predictors were responsible for 44% of the variability ofphysical healthcare practice. Nurses’ education level (degree levelor above) and prior training were significant predictors ofattitudes. The predictors of confidence were RGN qualification, worksetting, gender, and training. Inpatient nurses were more confidentthan those in a community setting. The findings answered the researchquestion successfully.


The lack ofrepresentativeness of the sample is a weakness that is associatedwith inappropriate conclusions. This limitation can be addressedthrough random sampling (Marschner I. C., 2014). Although theresponse rate of 52% is common in similar studies, it is low. Therate is likely to result in bias when there are differences betweenthe participants who return the questionnaires and those who don’treturn. Since it is a continuous process, assisting the participantsthrough each of phase of a survey will increase the response rate(Johnson, T. P. 2015). The phases of a survey are attention,intention, competition. Each phase is significantly linked to thenext. Influencing the attitudes and perceptions of the participantsin every phase will increase their likelihood of returning thequestionnaires.


From the studyconducted by Robson et al. (2013), it is evident that nurseshave a positive attitude and are willing to perform their roles ofdelivering physical healthcare service to patients with severe mentalillness. Additional training increases the attitudes of the nurses.The findings of this research are useful in the field of nursing.They can be used during strategic planning that aims at improving theperformance of nurses. Regular training of nurses and other healthprofessionals should be incorporated in strategic plans of healthinstitutions. Apart from enhancing attitudes, training also equipsnurses with new skills for addressing various issues encounteredwhile attending to individuals suffering from severe mental illness(Kozarek, Baron &amp Carr-Locke, 2013). Training should be based onthe nurses’ and patient’s needs. Nurses who smoke are more likelyto support smoking cessation programs. Therefore, nursing managersshould develop strategies that discourage smoking among the mentalhealth nurses as a way of reducing resistance towards programs forreducing the behavior.


Cherry, B., &amp Jacob, S. R. (2016).&nbspContemporary nursing:Issues, trends, &amp management. St. Louis, Missouri : Elsevier

Glasper, E. A., &amp Rees, C. (2017).&nbspNursing and healthcareresearch at a glance. West Sussex Hoboken, NJ : John Wiley &ampSons, Inc.

Johnson, T. P. (2015).&nbspHandbook of health survey methods.Hoboken, New Jersey : John Wiley &amp Sons, Inc.

Kozarek, R. A., Baron, T. H., &amp Carr-Locke, D. L. (2013).&nbspERCP.Philadelphia, PA: Elsevier/Saunders.

Marschner I. C. (2014), Inference Principles forBiostatisticians,CRC Press

Robson, D., Haddad, M., Gray, R., &amp Gournay, K. (2013). Mentalhealth nursing and physical health care: A cross‐sectionalstudy of nurses` attitudes, practice, and perceived training needsfor the physical health care of people with severe mentalillness.&nbspInternational Journal of Mental HealthNursing,&nbsp22(5), 409-417.

Stausberg M. &amp Engler S. (2013), The Routledge Handbook ofResearch Methods in the Study of Religion, Routledge