Happell, B., & Caderyn, J.G. (2012). The attitudes of undergraduate nursing students towards mental health nursing: A systematic review. Journal of Clinical Nursing, 22, 148-158. doi: 10.1111/jocn.12022
The Problem
The two research problems were clearly stated at the end of the introduction. The aim of the systematic review was to understand undergraduate nursing students’ attitudes towards mental health nursing. The introduction shed light on the problem by describing the need to attract more nurses into mental health, defining the concept of attitude, and proposing how undergraduate education may likely influence students’ attitudes towards mental health nursing. The 2 research questions help validate the authors’ presumptions by inquiring what the students’ attitudes were and the influence of undergraduate education. These questions establish the scope of the review which is appropriate in relation to the chosen problem.
Search Strategy
The search terms were identified as well and are exhaustive because all the key concepts in the research questions were represented. The different terms for a concept, if these exist, were considered. For example, “psychiatric” may be used in place of “mental health” so both were included in the search terms. The asterisk was also used with “nurs” as a wildcard symbol to facilitate the search for related words, namely “nurse,” “nurses” and “nursing” (U.S. NLM, 2015). Commitment to transparency which increases trustworthiness is evident in the inclusion of an appendix showing how the search terms were stringed together (Polit & Beck, 2012). In so doing, the search can be replicated and validated.
Finally, the authors used the PRISMA as framework for the literature search and a flow chart described the search process and results. Using an established protocol such as the PRISMA ensures that the systematic review plan is rational, methodological, and analytical and that the actual conduct is sufficiently documented (Shamseer et al., 2015). The trustworthiness and rigor of a systematic review rests on the quality of its planning and conduct (Shamseer et al., 2015). The flow chart in the article is part of documentation and serves as another transparency indicator. The authors manually searched the references page of the studies that fit the inclusion criteria to ensure no relevant studies are missed.
The Sample
As mentioned, inclusion and exclusion criteria were clearly discussed and were appropriate. The electronic and manual search narrowed down the studies to 21 articles with an aggregate sample of 4,462 undergraduate nurses. Nine of the studies were used to answer the first research question and 12 answered the second research question. For this reason, the search was able to produce a sufficient number of studies in a logical way. The authors identified the limitations to be 7 studies sharing two different data sets which meant the same sample of student nurses. No strengths were reported as was any instance of key information missing from the selected studies. The rationale of exclusion was provided and these pertained to not meeting the inclusion criteria or meeting the exclusion criteria but not because of insufficient information.
Quality Appraisal
Data Extraction
The data extracted included only methodologic aspects as can be concluded from the summary table of the selected studies. These aspects are sample size, study design, type of education/placement, outcome measures, and major findings. Sample characteristics for the studies on attitudes pertained to the sample size and the undergraduate level or type of placement of the student nurses. The studies on the effect of education included more descriptive information on the students’ education or placement. The information is adequate for readers to picture the types of students who took part in the studies. Sufficient information was extracted on study findings as the p values, pre-and post-test values, and other statistics that support such findings were presented. Only one of the 2 authors performed data extraction and was not blinded which could have affected the integrity of the study although the process was guided by a standard procedure (Hamric et al., 2014).
Data Analysis
In terms of quantitative data analysis, no meta-analysis was conducted because of limitations in the selected studies. Rankings were often used as outcome measures and there was wide heterogeneity in the statistical analyses to allow a meta-analysis. The issue of publication bias was not addressed. In terms of qualitative data analysis, the authors performed a meta-summary as they focused on the similarities and consistency in the research findings before abstractions were made regarding the research questions (Polit & Beck, 2012). The inferences are convincing and appropriate following a review of the extracted data on major research findings.
Potential Impact on Clinical Practice
The systematic review demonstrates that mental health nursing is consistently the least desired field of specialization among student nurses. However, the current shortage of mental health nurses means that more should be done to increase the number of these nurses in order to meet patient demand. The review findings show that students who were better prepared theoretically, had more experience in mental health through clinical placements, and perceived the important contribution of mental health nurses were more likely to enter this field. The findings therefore imply that to promote mental health nursing, the undergraduate curriculum should strive to improve students’ theoretical preparation, increase the number of mental health placements, and emphasize the positive aspects of mental health nursing.
Conclusions
References
Hamric, A.B., Hanson, C.M., Tracy, M.F., & O’Grady, E.T. (2014). Advanced practice nursing: An integrative approach (5th ed.). St. Louis, MO: Elsevier Saunders.
Polit, D.F., & Beck, C.T. (2012). Essentials of nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Stewart, L.A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ, 349(g7647). doi: http://dx.doi.org/10.1136/bmj.g7647
U.S. National Library of Medicine (NLM) (2015). Truncation. Retrieved from https://www.nlm.nih.gov/bsd/disted/pubmedtutorial/020_460.html
Voss, P.H., & Rehfuess, E.A. (2012). Quality appraisal in systematic reviews of public health interventions: An empirical study on the impact of choice of tool on meta-analysis. Journal of Epidemiology and Community Health, 67, 98-104. doi:10.1136/jech-2011- 200940
