A leading mental health expert says the nationalities and culture of nurses profoundly affects their attitudes to disturbed patients.
Whereas some nurses in mental health hospitals such as the Irish, consider themselves caring and considerate, those from Lithuania can be seen as more authoritarian when considering their own views while treating those with serious mental health issues.
As globally more than 450 million people suffer from mental health problems with 1 in 4 having experiences of mental health services at some point in their lives, the treatment they receive from mental health nurses is crucial.
Professor Mary Chambers, who works in the Faculty of Health, Social Care and Education at Kingston University and St George's, University of London, says this cultural disparity can also have consequences for patients.
"If some nurses hold negative attitudes toward the mentally ill this can impact on patients' recovery. If patients feel they are not been 'heard' by professionals this can lead to frustration and possibly anger, which may sometimes result in violence," she explained.
Professor Chambers said her latest study builds on work which began by looking at nurses' attitudes towards mental illness and pinpointed differences between countries.
The report says: "In general, mental health nurses' attitudes to mental illness and people with mental health problems are positive.
Overall, Portuguese nurses' attitudes are more positive than those of nurses in the other countries, while Lithuanian nurses' attitudes are more negative.
"Nurses in Italy, Finland and Ireland have fairly similar attitudes, though nurses in Finland had significantly more negative attitudes than Irish and Italian nurses on the benevolence and community mental health ideology scales.
"With the exception of England none of the countries had national guidelines regarding how to manage distressed and disturbed patients."
She examined the thoughts and feelings of nurses working in mental health in six European countries: England, Finland, Ireland, Italy, Lithuania and Portugal.
She explained: "Portuguese and Irish nurses had a more positive attitude towards service users while Lithuanian nurses tended to take a slightly more authoritarian approach to care."
During the past five years, Professor Chambers has jointly led the development of the international online education and training resource ePsycheNurse.net for mental health nurses.
The ePsycheNurse.net project was piloted in London and Finland and subsequently adopted by the Scandinavian country.
The research had shown that Finland leaned towards a more formal approach to mental health nursing, with people in psychiatric hospitals who became very agitated or disturbed sometimes restrained using straps or placed in seclusion, Professor Chambers explained.
She worked with academics, mental health professionals and service users in the country to develop an online curriculum to address these issues.
Drawing on experiences from nine European countries - England, Finland, Germany, Ireland, Italy, Lithuania, the Netherlands, Portugal and Switzerland - the project aims to give nurses the therapeutic tools to manage distressed and disturbed people in psychiatric hospitals and inpatient units sensitively and effectively, with safety and dignity paramount.
As part of the training, nurses were able to interact with virtual patients, developed with input from mental health service users, to practice responding to real-life clinical scenarios.
As a result, the use of restraint tools such as straps has now been completely eliminated and the number of instances of people being placed in seclusion has been significantly reduced from 300 to 30 per year in the Finnish hospitals in which the training has been implemented.
Professor Chambers says there is still a serious stigma around mental health issues that exists among some health professionals as well the general public.
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The full report is published in the Open Journal of Nursing: www.scirp.org/journal/ojn/