Original research Pan American Journal

of Public Healt

Nurses’ perception of
preparedness for moving mental
health care from psychiatric to
general hospitals in Jamaica
Claudine Douglas,1 Aileen Standard-Goldson,1 Kenneth James,1
Jamaica. Rev Panam Salud Publica. 2018;42:e158.
and Wendel Abel 1 https://doi.org/10.26633/RPSP.2018.158

Objectives. To examine nurses’ perception of readiness to

Suggested citation care for patients with mental illness at two general hospitals in
St. Catherine, Jamaica.
Methods. This mixed-methods, cross-sectional study was
conducted among nurses on the medical wards of two
ABSTRACT hospitals. A 39-item, self-administered questionnaire
containing open- and closed-ended questions and personal
interviews was used to assess the nurses’ preparedness to care
for mentally ill patients; their awareness regarding protocol
for care of mentally ill patients; their attitudes towards the
integration of mental health care into the general hospital
setting; and any associations between these and select
variables, e.g., education level, work experience; and
perceptions of the integration process.
Results. In all, 105 nurses completed the questionnaire
(response rate: 80%) and six nursing supervisors were
interviewed. Almost all (99%) felt the ward was unsuitable for
admitting mentally ill patients; 95% felt inadequately
prepared; and 73% were not aware that a standard
management protocol for treating patients with mental illness
was available. Staff training was deemed important. It was felt
that a special area should be established for managing
mentally ill patients. Conclusions. The shift of mental health
services was a strategic policy decision aligned with the
recommendations and support of the Pan American Health
Keywords Organization. This study shows the need for medication,
equipment, implementation of standard operating procedures,
adequate accommodation for patients, and staff trained to
provide quality care for patients with mental illness.
Noncommunicable diseases
(NCDs) are a major cause of
the global burden of disease,
of which neuropsychiatric
Douglas C, Standard-Goldson A,
James K, Abel W. Nurses’
perception of preparedness for
moving mental health care from
psychiatric to general hospitals in

1 Department of Community Health and Psychiatry, Faculty of Medical Sciences, University of the West Indies Mona
Campus, Kingston, Jamaica. Send correspondence to Aileen Standard-Goldson,
[email protected]

Rev Panam Salud Publica 42, 2018 1

 Original research Douglas et al. • Nurse readiness for moving mental health care to the general hospital
Mental disorders; nursing; services; nursing staff, hospital; psychiatric nursing; mental
community mental health health services; Jamaica.

2 Rev Panam Salud Publica 42, 2018

Douglas et al. • Nurse readiness for moving mental health care to the general hospital Original research
disorders account for approximately 25% illness in 2015. The related, estimated costs
(1). According to the Global Burden of for 2013 and 2014 were J$ 1.7 billion (US$
Disease Report 2016 (2), mental and 13.3 million) in expenses and J$ 859 million
substance use disorders are the largest group (US$ 6.7 million) in lost productivity due to
of diseases contributing to the non-fatal missed workdays. Trends point to future
burden of disease (18.7%). In Jamaica, increases in both the number of individuals
public health facilities treated almost 4% of treated and the related costs (3).
the population for mental
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There is a treatment gap admissions in Jamaica of the issue from several
between persons with mental occurred at such hospitals (8). angles, including the nurses’:
disorders and the provision of High quality outcomes in
care, especially in low- and psychiatric care in the general i. Self-reported
middle-income countries hospital setting are related to preparedness to care
(LMICs). In 2001, the World factors such as work for mentally ill
Health Organization (WHO) environment, staffing patients;
made 10 recommendations to complement, and level of ii. Awareness of protocols
reduce the treatment gap in training (9). Readiness for for care of the mentally
mental health (4). One of integration is influenced by ill;
these was shifting care from perceptions of mental illness, iii. Attitudes towards
institutions to community structural conditions of integrating mental
facilities. Specifically, WHO facilities, drug availability, health care within the
recommended that, “large and health worker- derived general hospital, and
custodial mental hospitals… stigma (10). Ascertaining associations between
be replaced by community readiness for integration and these and select
care facilities, backed by associated factors is sociodemographic
general hospital psychiatric implicitly important for the variables; and,
beds and home care support, successful shift from iv. Perception of the
which meet all the needs of specialized psychiatric process for integrating
the ill that were the hospitals to mental health care into
responsibility of those community/general hospitals. the general hospital
hospitals” (4). Saint Catherine, a parish in setting.
Jamaica, a Caribbean island southeast Jamaica, is one of
nation with a population of the island’s largest with a Study participants
2.9 million, is the third-most population of over 0.5
populous Anglophone million. The objective of this The study population for
country in the Americas (after study was to examine nurses’ the quantitative portion of the
the United States and perception of the readiness to study was all 130 nurses,
Canada), and is considered to manage patients with mental whether Enrolled Assistant/
be a middle-income country illness at two general Certified Nursing Assistant
(5). In 1972, Jamaica hospitals in St. Catherine, (CNA) or Registered Nurse
introduced the practice of Jamaica. (RN), employed by two
treating some persons with hospitals in St. Catherine,
mental disorders on the MATERIALS AND who had worked on the
medical wards of general METHODS medical ward for at least 3
hospitals (5) Studies indicate months during the 12 months
progress, success, and even, This was a mixed-methods prior to June 2017.
superior outcomes in patients study of convergent type with Permission was obtained
treated in the open medical quantitative and qualitative from the Nursing Office to
wards versus those treated in components conducted from distribute the questionnaire to
acute psychiatric units and June – July 2017 at two each nurse during the change-
mental hospitals (5 – 7). general hospitals in St. of-shift meeting (2 pm and 10
Since 2000, there have been Catherine. The hospitals were pm daily); this time was
sustained, systematic efforts designated Hospitals A and B chosen to minimize
to shift care to the community for the purposes of this study. interference with usual duties.
and to integrate mental health The design was chosen to In addition, purposeful,
into the primary health care capture general trends and criterion-based sampling was
setting. There are mental relationships, while used to select the nurses to be
health beds in medical wards simultaneously providing in- interviewed; the criterion was
of general hospitals, and in depth personal perspectives holding the position of Nurse
2017, data indicated that and gaining multiple pictures Supervisor on a medical ward
74.5% of all psychiatric

Rev Panam Salud Publica 42, 2018 3

 Original research Douglas et al. • Nurse readiness for moving mental health care to the general hospital
during the study period. Six holding the position of Nurse comparison, was used to
nurses were interviewed, Supervisor was assumed to corroborate and elucidate
three from each of the two give these nurses a broad quantitative findings.
hospitals. knowledge of related issues
and challenges. Interviews Ethics
Data collection with six nurses explored
views of the integration Permission to conduct the
Both quantitative and process, readiness for the study was obtained from the
qualitative data were process, and associated University of the West Indies
collected. Quantitative data concerns. The interviews Ethics Committee (Kingston,
were collected using a 39- were recorded. Jamaica), the South East
item, self-administered Regional Health Authority
questionnaire with closed- Data analysis (Jamaica) and the relevant
ended and Likert-Type hospital authorities. Informed
questions (11). The Quantitative data was consent was obtained from
instrument collected entered, coded, and cleaned participants. Two boxes were
sociodemographic variables, using IBM SPSS Statistics provided on the wards by the
in addition to education and software, version 17 (SPSS researchers; one for signed
training, awareness of Inc., an IBM company, consent forms, and the other,
management protocols for Chicago, Illinois, United for completed ques
mentally ill patients, care- States). Descriptive statistical tionnaires; this separation
related safety issues, beliefs summaries were generated maintained anonymity.
and attitudes regarding and appropriate statistical
mentally ill patients, self- tests applied; P values of ≤ RESULTS
reported preparedness to care 0.05 were considered
for mentally ill patients, and statistically significant. The The study was conducted
perceptions of suitability of qualitative data was subjected at two hospitals designated
the hospital facility for care to framework (thematic) Hospital A and Hospital B.
of such patients. analysis involving not sure; and 1 % said such a
The qualitative portion of transcription familiarization, room was available.
the study sought to explore charting, and interpretation Emergency plans to be
A total of 130 questionnaires were also increased (Spearman’s rho = 0.562, P = activated in
distributed at both hospitals; 105 were 0.001). Of the total respondents, 89 (84.8%) times of crisis
completed and returned (10 refused to had not completed any postgraduate or for dealing
participate and 15 were not completed by training. with a patient
the cut-off date). The overall response rate Both Hospitals A and B had the plurality acting out
was 80% (105/130); Hospital A had a of respondents with work experience within were not in
response rate of 83% (33/40), and B, 80% the 1 – 5-year range (41%). This was place
(72/90). followed by the 6 – 10-year range, with 30% according to
and 29% of respondents having over 10 61% of
Sociodemographic profile years of service. Throughout the year, nurses respondents.
are rotated to other wards or areas to gain In-depth
Table 1 shows the participants’ experience. The respondents’ time worked interviews
sociodemographic data. All were Jamaican on the medical ward ranged from 3 – 12 revealed that
nationals and females, from 23 – 54 years of months, most frequently 4 – 6 months and 7 nurses felt
age, with a mean age of 35.4 years ± 8.2 – 9 months. that the
years. facilities were
Educational levels were categorized into Readiness and preparedness not prepared
diploma (Enrolled/CNA), Bachelor of to admit
Science in Nursing (BScN/RN), and The majority of respondents (95%) at mentally ill
postgraduate certificate/degree. Overall, by both hospitals did not feel adequately patients; and
their highest level of education, 16 prepared to care for mentally ill patients, that there
respondents (15.5 %) had a post-graduate with 101 nurses (99%) reporting that the should be a
setting was not suitable. A safety room to special area
certificate/degree; 69 (65.7%) had a BScN;
for the
and 20 (19%) had diplomas. There was a house a patient who is acting out,
mentally ill
positive, moderate, and significant endangering others or him/herself, was
with guard
correlation between years of experience and reported as not being available by 93% (n =
rails, away
educational level; as years of experience 98) of the nurses; 6% (n = 6) were
from patients
increased, educational level with medical
nurses’ views on mental conditions.
health care in general (12). Qualitative data,
hospitals. The criterion of through merging and

4 Rev Panam Salud Publica 42, 2018

Douglas et al. • Nurse readiness for moving mental health care to the general hospital Original research
Medication availability mentally ill patients, the of the mentally ill; however,
and patient responses varied according to of those only 44% (n = 23)
management hospital, with Hospital B said the medication was
generally having a better available on the ward at both
When asked about the supply. Fifty percent (n = 52) hospitals (P > 0.05). During
availability of drugs and of nurses indicated that they the in-depth interviews,
equipment to care for were very familiar with the nurses agreed
medications used in the care
TABLE 1. Sociodemographic profile of 103 nurses improvise with gauze or
surveyed in a study of their perception of readiness for similar, which is not always
shift from psychiatric hospital to general hospital adequate.
psychiatric care in St. Catherine, Jamaica, 2017 The standard management
Hospital Aprotocol for Bthe care ofa the
Hospital
Variable Total P value
n % mentally
n ill% patient is a
Age in years document prepared and
distributed by the Ministry of
n 95 26 Health of Jamaica (13). In all,
76 respondents (73%) were
Mean and standard deviation 35.4 ± 8.2 35.8 ± 7.5 not aware of a standard
Range 23 – 54 25 – 54 management protocol, with
only 27% reporting that they
Gender (n = 103) were aware of this document
Female 103 33 32.0(Table 2). This
Male 0 0 0 policy/protocol was not seen
Highest education level attained (n = 105) on the ward by the six Nurse
Diploma (Enrolled/Certified Nursing Assistant) 20 7 35.0Supervisors who were
Bachelor of Science in Nursing 69 20 29.0interviewed; five were not
sure if one existed at all. One
Postgraduate degree/certificate 16 6 37.5Nurse Supervisor noted that
she had the chance to read the
that the supply needs to be more reliable since sometimes these protocol for the care of the
medications are out of stock. Equipment, such as restraints, is mentally
not always available, and the respondents have had to
Years of work experience in nursing (n = 103)

1–5 42 12 28.6 30 71.4 0.982

6 – 10 31 9 29.0 22 71.0

11 – 15 20 7 35.0 13 65.0

16 – 20 7 2 28.6 5 71.4

21 – 25 3 1 3.3 2 66.7

Months worked on medical ward (n = 88)

1–3 16 6 7.5 10 62.5 0.291

4–6 27 8 29.6 19 70.4

7–9 20 8 40.0 12 60.0

10 – 12 25 4 16.0 21 84.0

a
P value based on independent t-test. All other P values are based on chi-square tests or Exact tests as
appropriate. Source: Prepared by the authors from the study results.
TABLE 2. Nurses awareness of standard management protocol for management of
mentally ill patients by hospital in St. Catherine, Jamaica, 2017
Aware Not aware Total

n % n % n %
Hospital A 9 28 23 72 32 100
Hospital B 19 26 53 74 72 100
All 28 27 76 73 104 100
χ2 (1) = 0.00; P = 1.
Source: Prepared by the authors from the study results.

Rev Panam Salud Publica 42, 2018 5

 Original research Douglas et al. • Nurse readiness for moving mental health care to the general hospital
ill patient in the primary care setting, but had not the percentage disagreeing that it was
seen it in the hospitals. adequately prepared. No other significant
associations were identified.
Attitudes
Challenges and possible solutions
Attitudes toward delivery of mental health
care services and treatment of the mentally The nurses also shared some
ill patient in the general hospital setting recommendations on workable solutions to
were examined using Likert-style questions. some of the challenges they are facing in the
Select summaries are shown in Figure 1. health care system. Figure 2 outlines three
Table 3 presents bivariate analyses of the main themes—preparedness for integration,
relationships between these attitudes and patient care, and participant
educational level, years of nursing recommendations/solutions—and sub
experience, and time worked on medical -themes that emerged, with the
wards in the prior 12 months. There were interrelatedness of subthemes indicated by
statistically significant associations between the arrows.
educational level and attitudes towards The nurses spoke passionately about
treating mentally ill patients in the general staffing issues. This was a major concern for
ward and care of the mentally ill as being an the Nurse Supervisors, who reported staffing
important role of the nurse, respectively. As has implications for the quality of care and
educational level increased, so did the that there is a general shortage of nurses in
proportion displaying positive attitudes. As the health care system. They also felt that
time worked on the medical ward increased, the staff should have some specific mental
so did health training prior to initiation of the
integration process.
DISCUSSION

The finding that the majority of the respondents hold a BScN as their highest educational
attainment, coupled with the relatively few years of experience, suggest that nurses working
on the medical wards are junior nurses. As they gain experience, they are promoted to senior
positions away from bedside nursing on medical wards or they are moved to
specialized units, such as maternity, accident and emergency, surgery, and sometimes, to
supervisory positions. The loss of more senior, experienced nurses from direct bedside
nursing leaves the junior nurses with little direct supervision in patient care. Loss of senior
nurses from bedside nursing is also the result of migration to other jurisdictions that offer
better compensation packages and work environments (14). This creates a decreased
workforce to adequately care for the volume of patients seeking care at the general hospital.
Limited human
FIGURE 1. Attitudes and perceptions regarding aspects
of mental health care in a study of nurses’ perception of
readiness for shift from psychiatric hospital to general
hospital psychiatric care in St. Catherine, Jamaica, 2017

6 Rev Panam Salud Publica 42, 2018

Douglas et al. • Nurse readiness for moving mental health care to the general hospital Original research
Mentally ill patients should not be
61.0 9.5 29.5
cared for in a general hospital
(n = 105)

Caring for patients with mental 85.3 8.8 5.9

health problems is an important
part of the nurses' role (n =
102)

35.3 15.7 50.0

I have the skills to work with
patients with mental health
problems (n = 102)

16.2 8.6 75.2

Restraints must be used for all

mentally ill patients (n = 105)

11.6 14.6 73.8

Nurses were adequately prepared

for the integration of mental
health care in the general 0 20 40 60 80 100
hospital (n = 103) training of health care
workers is needed to develop
and reinforce skills (7).
Most respondents reported
Percent not being adequately prepared
Strongly agree / agree
to care for the mentally ill on
the general wards. Reasons
Undecided Disagree / strongly disagree Source: Prepared by the given were inadequate setting,
authors from the study results. lack of training, shortage of
staff, and lack of equipment
and drugs for the care of these
patients. Therefore, as
indicated by previous studies
resources result in inadequate mental health care (7). Abel and (15, 16), there is a need for
colleagues posit that greater emphasis needs to be placed on training and education to
training specialized mental health nurses (7). improve nurses’ knowledge
This current study has shown that almost 85% of and confidence when caring
respondents had not completed a post graduate training for patients who are mentally
program of any type. Our results revealed that attitudes toward ill. There is concern whether
mental health care on the general wards is positively related to patients will receive necessary
educational level. So too is the perception of the role of the and quality care given the
nurse as important to caring for the mentally ill. Training is limited human and material
thus of paramount importance. The training of nurses to deliver resources available.
a wide range of mental health services can help to address the
lack of human resources in this area. Additionally, continuous
TABLE 3. Attitudes by highest level of education, years of nursing experience, and
time worked on medical wards in the past year among participants in a study of
nurses’ perception of readiness for shift from psychiatric hospital to general hospital
psychiatric care in St. Catherine, Jamaica, 2017
Variable n Highest education level attained n Years of nursing experience (%) n Months on medical ward
(%) (%)
Mentally-ill should not be nursed on 105 Diploma BScN Post-graduate 103 1 – 6 – 10 11 – 15 16 – 20 21 – 25 88 1 – 3 4 – 6 7 – 9 10 – 12
general ward 5
Strongly disagree/disagree 31 55.0 24.6 18.8 30 21. 38.7 35.0 14.3 33.3 26 31.3 29.6 40.0 20.0
4
Undecided 10 5.0 13.0 0.0 10 14. 9.7 5.0 0.0 0.0 8 18.8 7.4 5.0 8.0
3
Strongly agree/agree 64 40.0 62.3 81.3 63 64. 51.6 60.0 85.7 66.7 54 50.0 63.0 55.0 72.0
3

Rev Panam Salud Publica 42, 2018 7

 Original research Douglas et al. • Nurse readiness for moving mental health care to the general hospital
P valuea 0.038 b 0.706 0.631

Caring for mentally–ill patients: 102 100 85

important part of nurse’s role
Strongly disagree/disagree 6 21.1 3.0 0.0 6 2.4 10.0 10.5 0.0 0.0 6 0.0 7.7 15.0 4.2
Undecided 9 0.0 10.4 12.5 9 9.8 13.3 5.3 0.0 0.0 8 13.3 3.8 15.0 8.3
Strongly agree/agree 87 78.9 86.6 87.5 85 87. 76.7 84.2 100.0 100.0 71 86.7 88.5 70.0 87.5
8
P value 0.043 b 0.793 0.517

Have skills to work with 102 101 85

mentally ill patients
Strongly disagree/disagree 51 50.0 51.5 43.8 51 57. 55.2 30.0 42.9 66.7 43 35.7 44.4 60.0 58.3
1
Undecided 16 0 20.6 12.5 16 16. 20.7 5.0 14.3 33.3 15 14.3 22.2 15.0 16.7
7
Strongly agree/agree 35 50.0 27.9 43.8 34 26. 24.1 65.0 42.9 0.0 27 50.0 33.3 25.0 25.0
2
P value 0.130 0.081 0.707

Restraints must be used for all 105 103 88

mentally -ill patients
Strongly disagree/disagree 79 85.0 73.9 68.8 77 69. 80.6 70.0 85.7 100.0 68 81.3 66.7 85.0 80.0
0
Undecided 9 5.0 11.6 0.0 9 14. 6.5 5.0 0.0 0.0 9 12.5 14.8 5.0 8.0
3
Strongly agree/agree 17 10.0 14.5 31.3 17 16. 12.9 25.0 14.3 0.0 11 6.3 18.5 10.0 12.0
7
P value 0.306 0.875 0.820

Nurses adequately prepared for 103 102 86

integration of mental health care
into general hospital
Strongly disagree/disagree 76 84.2 67.6 87.5 76 76. 66.7 85.0 71.4 66.7 63 46.7 63.0 80.0 95.8
2
Undecided 15 5.3 17.6 12.5 14 11. 20.0 0.0 28.6 33.3 12 26.7 18.5 10.0 4.2
9
Strongly agree/agree 12 10.5 14.7 0.0 12 11. 13.3 15.0 0.0 0.0 11 26.7 18.5 10.0 0.0
9
P value 0.335 0.330 0.015 b

a
All p-values based health standards, creates potentially greater
on Fisher’s exact
mental health policies, and indifference, inconsistency of
test. b Statistically
significant at 0.05 reviews and monitors mental action, and legal risk.
level. health programs in the Studies done in Jamaica
Source: Prepared by the authors country. These policies are have indicated that the care
from the study results. distributed to the clinical outcome of patients with
areas where they are utilized mental disorders treated in the
in the daily management of open medical ward can be
patient care. However, this superior to those treated in
Interestingly, nurses who policy/protocol document had specialized acute care
had spent more time on the not been read by the majority psychiatric units and mental
medical ward were more of our study respondents. It is hospitals (6). Required drugs
likely to report that nurses important that the document and equipment are necessary
were inadequately prepared be available to instruct the to facilitate effective nursing
for the integration of mental users how to proceed in care. Abel and colleagues (7)
health care into the general specific situations. Its use is state that in order to reduce
hospital setting. We posit that critical to the development of the burden and treatment gap
longer exposure increases the mental health services and associated with mental
appreciation of the challenges systems, and its reported disorders, there must be
presented by the shift of care absence by nurses is of adequate financing. A budget
and greater realization of the concern. These policies guide oriented towards treating
degree of inadequate mental health care and mental health problems will
preparation. facilitate the provision of determine the extent to which
A WHO report (17) states psychotropic drugs, and a country can effectively
that the mental health unit in treatment in the community implement and sustain mental
the Ministry of Health of and at general hospitals (5). health policies, programs, and
Jamaica develops mental Without this, there is services. Noting that in many

8 Rev Panam Salud Publica 42, 2018

Douglas et al. • Nurse readiness for moving mental health care to the general hospital Original research
countries in Latin America hospitals continues, the Pan towards decentralization of
and the Caribbean, American Health mental health services (18).
disproportionate spending on Organization (PAHO) has This, however, cannot occur
specialized psychiatric urged increased efforts in a vacuum
FIGURE 2. Diagram of three main emergent themes 5. Abel W, Sewell C, Thompson E, Bro
and sub-themes in a study of nurses’ perception of 59. Mental health services in Jamaica:
readiness for shift from psychiatric hospital to 3. Jones R. Mental Emergency! More than institution to community. Ethn Inequ
general hospital psychiatric care in St. Catherine, 107,000 Jamaicans treated for psychological Heal Soc Care. 2011;4(3):103–11.
Jamaica, 2017 care skill and competency.
This should be accompanied
Preparedness for Patient care by Recommendations/
adequate supervision of
integration personnel solutions
by staff specifically
trained in mental health care
Staffing challenges and the distribution of mental
health care policy and
protocol documents to staff.
Training
Facility readiness Staffing levels should be
Patient safety bolstered, at least initially,
through the use of psychiatric
Increased staff
nursing complement
aides. Facility
Policy infrastructure and drug and
equipment availability must
Equipment and drugs
be improved to enhance
patient management. Bi-
Source:Prepared by the authors from the study results. annual or annual audits of
hospitals by the Ministry of
Health/ Regional Health
Authority to assess gaps in
and requires strategic approaches that studies that the mentalthe
explore health patient care
facilitators for
recognize critical elements for success, delivery process
hospital implementation of mentalshould be
health
including preparedness for integration, care policies. conducted. Though not
addressing patient safety issues, and Limitations.generalizable, the lessons
providing appropriate staffing. two hospitals in learned from in
one parish thisJamaica—its
study may
Nurses do and will play important roles in findings cannot be be instructive
generalized to allothers such
the realization of the shift of psychiatric hospitals given working in resource-limited
the variations in staffing,
care to general hospitals. Consequently, the range and level areas in Latin infrastructure,
of services, America and
expressed concerns, perceptions, and the Caribbean.
and drug availability. The study was not
challenges are germane to this process. Nursing trends
longitudinal; therefore, staff are at the
cannot be
Incorporation of in- service clinical assessed. frontline
Nurses of
interviewed care for
were mentally
from a
attachments in psychiatry can help increase single, ill
geographic patients
area, and admitted
their to
views the
and
nursing knowledge and competence (19). experiences may generalnot wards
span thewhere gamutthey of
The innovative use of psychiatric nursing existing viewsprovide 24-hour care. The
and experiences.
aides may partially alleviate shortages of shift of mental health services
Conclusions to the general hospital setting
fully trained nursing personnel (20).
was a strategic move by the
Findings from this Jamaican study argue for
There should health
be anauthorities
increase inofpost-Jamaica,
basic
Member States to reflect on and appraise the
psychiatric consistent
training of with the
nurses in PAHO
general
extent to which such issues are given
vision.mental
hospitals to increase This move,
health however,
attention. There is a need for further must be supported by the
supply of drugs and
equipment, implementation of
standard operating procedures
and protocols, adequate
1. Abel WD, Richards-Henry M, Wright EG, accommodation
issues last year. The Gleaner. 22 forMay
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2016.
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2. Vos T, Abajobir AA, Abbafati C, Abbas KM, 17 Februarypsychiatric
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Abate KH, Abd-Allah F, et al. Global, regional, 4. World Healthhospital are The
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injuries for 195 countries, 1990-2016: a Available Conflicts
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declared.
Disease Study 2016. Lancet. 2017;390:1211– 17 February 2018.

Rev Panam Salud Publica 42, 2018 9

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Disclaimer. Authors hold sole responsibility for the views 2005;44(2):255–67. 20. Gardner C. Health Ministry to increa
expressed in the manuscript, which may not necessarily reflect 16. McCann T, Clark E, McConnachie S, Harvey complement of psychiatric nursing aid
I. Accident and emergency nurses’ attitudes 2017. Available from: https://jis.gov.j
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Available from: http://cochranelibrary-wiley.com/doi/ 10.1002/ mental health services to widen access,
14651858.CD003290. pub2/ abstract; jsessionid= protect human right. 2015. Available from: Manuscript received on 28 February 2018. Accepted
F0FE76F5C5DE4E9 CA92BCA899 BCA50FD. f04t02 Accessed publication on 20 June 2018.
17 February 2018. Objetivos. Examinar la
7. Abel WD, Kestel D, Eldemire-Shearer D, Sewell C, Whitehorne-
Smith P. Mental health policy and service system development in percepción de las
the English-speaking Caribbean. West Indian Med J. 2012;61(5): enfermeras sobre la
475–82. preparación para atender a
8. Jamaica Ministry of Health. Vitals: a quarterly report of the pacientes con
Ministry of Health. Kingston; May 2018. https://www.moh.gov. enfermedades mentales en
jm/ wp-content/uploads/2018/06/VITALSMay-2018.pdf Accessed
6 June 2018. dos hospitales generales
9. Hanrahan NP, Aiken LH. Psychiatric nurse reports on the quality en St. Catherine, Jamaica.
of psychiatric care in general hospitals. Qual Manag Health Care. Métodos. Se llevó a cabo
2008;17(3):210–7. un estudio transversal, de
10. Gwaikolo WS, Kohrt BA, Cooper JL. Health system preparedness
métodos mixtos, entre las
for integration of mental health services in rural Liberia. BMC
Health Serv Res. 2017; enfermeras de los
17(1):508. pabellones médicos de dos
11. Joshi A, Kale S, Chandel S, Pal DK. Likert Scale: Explored and hospitales. Se utilizó un
Explained. British Br J Appl Sci Technol. 2015;7(4): 396–403. cuestionario
12. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the
autoadministrado con 39
framework method for the analysis of qualitative data in multi-
disciplinary health research. BMC Med Res Methodol. ítems que contenía tanto
2013;13(117): https://doi. org/10.1186/1471-2288-13-117 preguntas abiertas como
Accessed 6 June 2018. cerradas y entrevistas
13. Ministry of Health of Jamaica. Protocol for the management of personales, para evaluar la
common mental
preparación de las
enfermeras en cuanto a
protocolos y atención de
pacientes con
enfermedades mentales;
sus actitudes hacia la
integración de la atención
de salud mental en el
entorno hospitalario
general; cualquier
asociación entre estas y las
variables seleccionadas,
RESUMEN
por ejemplo, nivel
educativo, experiencia
Percepción de las enfermeras sobre la laboral; y sus percepciones
preparación para trasladar la atención acerca del proceso de
integración. Resultados.
de salud mental de los hospitales En total, 105 enfermeras
psiquiátricos a los hospitales completaron el
generales en Jamaica cuestionario (tasa de
health disorders MOH-DOC- 100- 3/512 October respuesta: 80%) y se
www.paho.org/hq/index.php?option=
2005 content&view= entrevistó a seis
14. Tomblin Murphy G, MacKenzie A, Waysome supervisores
11359&Itemid=1926&lang= de
B, Guy-Walker J, Palmer R, Elliott Rose A, et February 2018. enfermería. Casi todos
al. A mixed-methods study of health worker 19. Abera M, Tesfaye M, Belachew T, Hanlon C.
(99%) consideraron que la
migration from Jamaica. Hum Resour Health. Perceived challenges and opportunities arising
2016;14(36): doi: 10. 1186/ s12960-016-0125- from integrationsala no era
of mental adecuada
health para
into primary
8. Accessed 6 June 2018 admitir survey
care: a cross-sectional pacientes con
of primary
15. Mackay N, Barrowclough C. Accident and enfermedades
health care workers mentales;
in southwest el
Ethiopia.
emergency staff’s perceptions of deliberate BMC Health Serv 95%Res. 2014;14(113):
consideró que doi:no
self-harm: Attributions, emotions and 10.1186/1472-6963-14113. Accessed 17
estaba preparado
willingness to help. Br J Clin Psychol. February 2018.

10 Rev Panam Salud Publica 42, 2018

Douglas et al. • Nurse readiness for moving mental health care to the general hospital Original research
adecuadamente; y el 73% no sabía que está disponible un mental. A capacitação do
protocolo estándar para atender pacientes con enfermedad profissional foi considerada
mental. La capacitación del personal se consideró importante. Estabeleceu-se
importante. Se planteó que se debería establecer un área que deveria ser creada uma
especial para la atención de pacientes con enfermedades área especial para o controle

mentales. de pacientes com doenças

Conclusiones. El cambio de los servicios de salud mental fue mentais.
estratégica alineada con las recomendaciones y el apoyo de la Organización Panamericana de
la Salud. Este estudio muestra que es necesario disponer de medicamentos, equipos,
implementación de procedimientos operativos estándar, una ubicación adecuada de los
pacientes y personal capacitado para proporcionar una atención de calidad a los pacientes con
enfermedad mental.

Palabras clave Trastornos mentales; enfermería; servicios comunitarios de salud mental; recursos humanos en
enfermería; personal de enfermería en hospital; enfermería psiquiátrica; servicios de salud
mental; Jamaica.
una decisión política RESUMO Conclusões. A mudança dos
serviços de saúde mental foi
uma decisão política
Percepção das enfermeiras sobre a estratégica alinhada com as
preparação para transladar a atenção à recomendações e o apoio da
saúde mental dos hospitais Organização Pan-Americana
da Saúde. Este estudo mostra
psiquiátricos para os a necessidade de
hospitais gerais em Jamaica medicamentos, equipamentos,
a implementação de
procedimentos operacionais
padrão, um localização
adequado dos pacientes e o
suporte dos mesmos com
pessoal capacitado para
prestar cuidado de qualidade a
pacientes com doença mental.

Palavras-chave

Objetivos. Examinar a percepção das enfermeiras sobre a

preparação para atender a pacientes com doenças mentais em
dois hospitais gerais em St. Catherine, Jamaica. Métodos. Foi
realizado um estudo transversal, de métodos mistos, entre as
enfermeiras dos pavilhões médicos de dois hospitais. Foi
utilizado um questionário autoadministrado com 39 itens que
continha tanco perguntas abertas como fechadas e entrevistas
pessoais, para avaliar a preparação e conhecimento das
enfermeiras em quanto a protocolos e atenção de pacientes com
doenças mentais; suas atitudes para a integração da atenção à
saúde mental no entorno hospitalar geral; qualquer associação
entre estes e das variáveis selecionadas, por exemplo, nível
educacional, experiência profissional; e percepções do
processo de integração.
Resultados. Em total, 105 enfermeiras completaram o
questionário (taxa de resposta: 80%) e se entrevistou seis
supervisores de enfermaria. Quase todos (99%) sentiram que a
sala não era adequada para admitir pacientes com doenças
mentais; 95% sentiu que não estava se preparado
adequadamente; e 73% não sabia que está disponível um
protocolo de gestão padrão para tratar pacientes com doença

Rev Panam Salud Publica 42, 2018 11

 Original research Douglas et al. • Nurse readiness for moving mental health care to the general hospital
Transtornos mentais; enfermagem; serviços comunitários de
saúde mental; recursos humanos de enfermagem no hospital;
enfermagem psiquiátrica; serviços comunitários de saúde
mental; serviços de saúde mental; Jamaica.

12 Rev Panam Salud Publica 42, 2018