CHAPTER II

Review of Related Literature

In this chapter, the researchers gathered various literature from different sources,

journal and the internet which provided necessary knowledge in order to pursue the

study, this study focus on factors affecting nursing students’’ decision in pursuing a

career in psychiatric nursing.

Psychiatric nursing as a career

Workplace aggression toward nurses in the Philippines was examined by (Fujishito

et., al, 2011) as cited by Magtubo and the team found that both physical and verbal

form of aggression are present in the healthcare system and the study revealed that 1

in 14 nurse participants reported physical abuse while 1 in 3 experienced a verbal

abuse.

Faced with a violent situation, a psychiatric nurse often struggles with ole conflict-

performing ones duty to care for a patient on the duty to protect one’s self. He used

an interpretive descriptive design in his study and it includes 17 semi-structured

interviews with a purposeful sample of 12 Canadian RNs who self-reported

experiencing patient violence within acute care inpatient psychiatry. And a thematic

analysis and constant comparison techniques were also used for analysis. And for the

result, nurses endorsed the need for improved education, debriefing following an

incident and supportive work environment to further prevent patient violence

(Stevenson, 2015).
In the article that was stated by de Nesnera & Allen (2016), the Psychiatric mental

health nurses practitioners (PMHNPs) are taking on increasing clinical responsibilities

when delivering mental health services to individuals with a wide variety of mental

illness. . It is said that the evolution of PMHNPs in treating patients with mental

illness is difficult linked to their ability to act as independent practitioners.

Stuart (2013) also mentioned that mental health nurses do find it draining when

patient communicates a prolonged and intense expression of emotions such as

sadness, despair or anger. Nurses who employ deep acting - meaning interactions

where more varied intensified emotions are shown - need to exert more ‘’emotional

labour’’ as mentioned to a mental health study by (Mann et al. 2005; Cowburn ,

2005).

According to (Sue at al., 2012) that one way to narrow the discrepancies in utilization

of mental health service in through a better understanding of the conceptualization of

mental illness.

Providing nursing care for people who are suffering from psychiatric disorders is

emotionally demanding and burnout is after the consequence of long continued

exposure to this stressful working situation. Conditions associated with stigma such as

stereotyping, discrimination and fear among others have consequences for the access

of persons with mental illness to the general health services, in terms of the negative

perception that the health team have may have this type of patient (Greene-Shotridge

et al., 2007; Acuña& Bolis, 2005)

The study of (Arafa et al., 2003; Edward & Burnard, 2003) that workload,

collaboration with other professionals, confidence and competence in the nursing role

and lack of support are examples of areas that have been highlighted as major sources

of stress for psychiatric nurses.

A systematic review of (Edward & Burnard, 2003) the method of their study was

limited to primary research papers that specifically involved mental health nurses

where the health outcomes measures are stressors, moderators and stress outcome.

And the result of their study is that the relaxation techniques, training in behavioral

techniques, stress management workshops and training in therapeutic skills were

effective stress management techniques for mental health nurses.

(Wai-Tong Chien & Yin Sin-Yin Yick, 2016) the nurses’ job satisfaction was

negatively correlated with their job stress and intention to quit; whereas the nurses’

job stress was positively correlated with their intention to quit. The nurses with older

in age and more post registration experience and for working experience in the private

hospitals indicated a higher level of job satisfaction particularly with pay and

autonomy according to the result of the study of (Wai-Tong Chien & Yin Sin-Yin

Yick, 2016).

As stated by (Willem et al., 2007) job satisfaction among health professionals is a

topic of global interest for a long time. The study topic persists to be important

because it affects the employees (professionals) job performance and subsequently

quality of hospitals and health care services according to (Willem et al., 2007; Leung

et al., 2007). However, Philippine folk conceptualizations of illnesses do not

differentiate between physical and mental disorder and a review of how both medical

and psychological illnesses are framed suggests that Filipinos conceptualize disorders

differently from the medical model according to (Araneta 1993; Tan, 1987, 2005)

There has been a shortage of nurses choosing the specialize or work in mental health

settings over the years (Browne et al., 2013; De Kock & Pillay, 2016; Olfson, 2016).

Mental health was rated as one of the least preferred areas of nursing for a potential

career according to systematic review conducted by (Happell & Gaskin, 2013). And

other studies like (DeKeyser Ganz & Kahana, 2006; Stevens et al., 2013). A number

of studies have examined the different factors associated with nursing students’ choice

of selecting psychiatric nursing as a specialty (Happell, 2008; Hunter et al., 2015;

Thongpriwan et al., 2015).

According to a thematic analysis of qualitative interviews of (Galvin J. et al., 2015),

the participants reported unreasonable demands during clinical blocks and they

described how control or support is lowest on placements with staff shortages and

negative attitudes towards students from staff and related issues were also discussed

ad their younger participants described struggling with mental work during the early

stage of training.

There are similar findings in other groups of mental health professionals and

conducted that alarmingly high number of mental health workers may fail to adopt

positive coping strategies to manage their own stress as reported by (Jordaan et al.,

2007). A stratified random sample was used in this study and has 238 South African

clinical and counseling psychologist completed internet surveys that included a

biographical questionnaire, BDI, STAI and brief COPE. And its results suggest the

South African psychologist fail to manage their emotional stress in depressive and

anxiety symptoms.

Understanding mental health

Mental health is defined by the World Health Organization (WHO) as "a state of well-

being in which every individual realizes his or her own potential, can cope with the

normal stresses of life, can work productively and fruitfully, and is able to make a

contribution to his or her community" (WHO, 2014)

There is no single, universal definition of mental health exists. It is also stated that

mental health is a state of emotional, psychological, and social wellness evidenced by

satisfying interpersonal relationships, effective behavior and coping, positive self-

concept, and emotional stability as stated by (Videbeck, 2011)

(Tugade, 2017) cited National Center for Mental Health (NCMH) that the statistics

project suicide rates of 2.5 men and 1.7 for women per 100,000 members of the

population and he also cited the report of World Health Organization in 2014 that

there are there were 2,558 cases of suicide due to mental health problems in the

Philippines in the year 2012 alone. As a public health concern, mental illness hits the

most vulnerable sectors of society the young and the poor.

In 2017, the Senate of the Philippines approved Philippine Mental Health Bill (Senate

Bill No. 1345), which efficiently makes mental health services such as psychosocial,
neurologic and psychiatric services available for common people in both urban and

rural areas. It only awaits the approval from the House of Representatives and

President Duterte’s signature (Manila Standard & Labon, 2017).

In the study of De Los Santos “A socio- ecological Framing of the Philippine Mental

Health Act of 2017” he cited (Tuliao, 2014) he mentioned that stigmatization of

people with mental health is prevalent in the country and is deeply ingrained in

Filipino culture despite numerous reports regarding stigmatization of mental health in

the country but only few qualitative studies to support this statement
Mental Health Facilities and Services in the Phillipines

In the study of Peralta “IN YOUR HEAD: A study on the uses and gratifications

and literacy of selected Metro Manila users’ tweeting using mental health

terms” she cited (Shahani, 2014) according to the study, the Philippines has

the two largest mental health facilities are Sanctuary Center and the

National Center for Mental Health (NCMH), both in Mandaluyong. These

centers treat and rehabilitate people suffering from mental disorders. Most

of the patients suffer from psychosis or schizophrenia. Like most public

hospitals, these centers are often lacking in terms of funds and have to resort

to soliciting donations from the private sector. There are also only around a

thousand mental facilities distributed all over the country; six regions,

including Ilocos, CARAGA, and Davao without any inpatient psychiatric

facilities. And it is said in the study that there are barangay health centers as

well that aim to cater to the needs of the local community. The quality of

care these community doctors can provide is questionable, though, according

to Dr. Bernardino Vicente of the National Center of Mental Health. In fact,

in many provincial hospitals and health centers, there are no psychiatrists or

mental health care experts. As of 2014, there were only 500 certified

psychiatrists in the country, leaving Filipinos direly in need of mental health

experts.
De los Santos cited (Girlbert et., al, 2015) suggested that in order for a program

to be successful, further funding, staffing and research models are

recommended. In the study of (De los santos, 2018) many Filipinos

experience numerous barriers to mental health care in the country such as

stigmatizationof illness and behaviors, lack of mental health care services

and resource deficits. He also concluded in order for a better understanding

of the barriers the researchers shiuld use a qualitative research. (Shahani,

2014) stated that there are barangay helath centers as well that aim to cater

the needs of the local community but in provincial hospital and health

centers there are no psychiatrist or mental health care experts. And it also

revealed that there are 500 certified psychiatrist in the country, leaving the

people in need of mental health experts.

Synthesis

According to different journal, articles and internet, psychiatric nurses often struggles

to perform their duty and responsibilities in taking care of their patient due to violent

situation and they did find it draining and they have failed to adopt a positive coping

strategies to manage their own stress when handling psychiatric patients. Despite that

psychiatric nurses are facing this kind of aggression among patients, the researcher

specifically want to determine why they are still continuing to work in a mental health

institution. There is need for better mental health facilities and a better understanding
for mental health. There is also need for educate appropriately to encourage to use

proper coping strategies in dealing with patients.

Theoretical Framework

Theoretical Framework Framework that will be using for this study is Herzberg

Motivation- Hygiene theory. Motivation factors indicates (satisfaction) and hygiene

for (no satisfaction). And according to Herzberg, there are separate factors leading to

no job satisfaction. Herzberg also described 4 basic states; a. High motivation and

high hygiene that indicates a perfect state of happy and motivated employees, 2. High

motivation and Low hygiene that indicates motivated employees who loves their work

and has a few complains, 3. Low motivation and high hygiene indicates that bored

employees who only have for a paycheck and 4. Low motivation and low hygiene it

indicate that it is the worst and unhappy employees. We, researchers chose this theory

to be able to identify the factors that motivates and demotivates the employees

especially in a mental health institution and using this model to help us to identify

despite of the hygiene factor, why did the employees are still working in a mental

health institution.

Research Paradigm
According to the

study of (Janer et., al,

that the nurses should

separate things with

their problems at

home and at work

The research paradigm illustrated how different factors affect nursing decision in

pursuing a career in psychiatric nursing, which includes age, sex, and religion. The

single arrow pointing toward the box of Factors affecting nursing students’ decision in

pursuing a career in psychiatric nursing which represent the effect, from the box that

represent the student demographic profile that implied as cause, explained that

independent variable causes an effect to the dependent variable. Thus, gives emphasis

that relates to factors affecting nursing students’ decision in pursuing a career in

psychiatric nursing and serves as a basis on significant difference of each factor. The

researchers evaluated the significance between the variables presented and used a

questionnaire and interview that is obtained to valid data.

 CHAPTER III

Research Methodology

This chapter deals with the methodology used by the researchers in this study

which includes the research design, sampling and population, research locale,

research instrument, ethical consideration, data gathering procedure, and statistical

analysis.

Research Design

This study will use a concurrent embedded type of mixed method. Mixed method

research is a methodology for conducting research that involves, collecting, analyzing

and integrating quantitative and a qualitative research. And it is also stated that this

type of approach to research is used when this integration provides a better

understanding of the research problem than either of each alone. By mixing both

qualitative and quantitative research and data, the researcher gains in extent and deep

of understanding and verifying, while offsetting the weakness inherent to using

approach by itself (“Qualitative Research” 2009).

Embedded design, this is the type of concurrent mixed method. Embedded design

is a small amount of either qualitative or quantitative data is included within a larger

quantitative and qualitative study (Public health workforce Training). And also

embedded mixed method which one data set provides a supportive, secondary role in

a study based primarily on the other type of data according to Creswell & Plano

(2011).
 We, researcher will use this design to include qualitative data to answer a

research question within a largely quantitative study and to also know the factors

affecting nursing students’ decision in pursuing a career in psychiatric nursing. And

also the because the findings from one approach can be greatly enhanced with a

second source of data.

Sampling and Population

A purposive sample will be used in conducting the study, it is a non-probability

sample. Purposive sampling is based on the belief that researchers’ knowledge about

the population can be used to hand-pick sample members and non-probability sample

is when researchers select elements by nonrandom methods in which every element

usually does not have a chance to be included (Polit & Beck, 2014).

The researchers have chosen purposive sampling to be able to decide purposely to

select people who are judged to be particularly knowledgeable about the issue under

the study

The respondents of the study will be Level 4 nursing students who have taken

NCM 105 Care of Clients with Maladaptive Pattern who have related learning

exposure on Mental Health Institution specifically Cavite Center for Mental Health,

who are currently enrolled at St. Dominic College of Asia 1st semester of Academic

Year 2018-2019. The researchers will be choosing this respondent because they have

insight, knowledge and experience on Psychiatric Nursing.

Research Locale

The study will take place at St. Dominic College of Asia, the institution is

located at Bacoor, Cavite . Located at the northeasternmost corner of the Province of

Cavite, Bacoor is approximately 17.5 kilometers southwest from Manila (from

kilometer zero), and about 27 kilometers northeast from Trece Martires City, the

provincial capital.Bacoor’s northern section is a coast fronting Bacoor Bay and

separated by the Zapote River and the Imus River on its eastern and western boundary

respectively (“City of Bacoor,” 2017).

St. Dominic College of Asia has reached a milestone on taking digital lea[p. and it

recently titled the Digital Campus Academy when it became the Certified 1st Digital

Campus Academy in Region 14. The researchers believe that St. Dominic College of

Asia will play a role on nursing students’ decision in pursuing a career in psychiatric

nursing in terms of course effectiveness of the institution.

Research Instrument

The instrument that will be use in the qauntitative part of the study is adopted

survey questionnaire from Hayman-White & Happell (2005), Survey questionnaires

will be provided to the respondents to gather demographic data and to determine the

factors that affects nursing students’ decision in pursuing a career in psychiatric

nursing in a form of likert scale. After answering the questionnaire the researcher will

conduct an interview which is qualitative part of the study with the respondents

answering the question that was prepared, gather information so they would able to

help findings from one approach enhanced with a second source of data.

Ethical Consideration

The researchers will be discussing the rights, benefits, and risk of the study to

the respondents for full disclosure. The respondents will also have right to self

determination which mean they have freedom to control their own activities including

their voluntary participation in the study. Participants will be fully informed regarding

the objectives of the study, while they will be reassure that their answers will be

treated as confidential and used only for academic purposes and only for the purposes

of the particular research.

Data Gathering Procedures

The researchers will be using an adapted questionnaire about factors in choosing a

career in mental health nursing and will interview the respondents about their

perception on psychiatric nursing

The researchers intend to write a letter of request to the Dean of College of

Nursing to ask permission for the conduct of the study.

 The researchers will explain to the respondents the importance of the study and

personally distribute survey questionnaire after answering the survey questionnaire

the interview will take place simultaneously.

Statistical Analysis

1.To answer question no 1, percentage and frequency count will be used.

Frequency analysis it is an important area of statistics that deals with the number

occurrences and analyzes measures of central, tendency, dispersion, percentiles and

etc. and it is also the number of time an event occurs while percentage frequency

distribution is a display of data that specifies the percentage of observations that exist

for each data point or grouping of data points. We will use this in order to determine

the percentage usually for data on profile.

2.To answer question no 2 Statistical treatment will be use. it allows you to take

a large amount of data and summarize it.

3.To answer question no 3, Chi- square to identify the significant relationship of

factors affecting nursing students in pursuing a career in psychiatric nursing when

grouped according to demographic profile. To measure the demographic profile of the

respondent, the researchers will utilize frequency, percentage and distribution, and

weighted mean.

4.To answer question no 4, Statistical treatment will be use. it allows you to take

a large amount of data and summarize it.