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Bachelor's Thesis

Degree programme in Nursing

General Nursing

2011

Olasoji Awoyera

ATTITUDE OF STUDENT
NURSES’ TOWARD PEOPLE
WITH DISABILITIES
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BACHELOR´S THESIS | ABSTRACT

TURKU UNIVERSITY OF APPLIED SCIENCES

Degree programme in Nursing| General Nursing

Completion of the thesis| Total number of pages 48

Instructors Heikki Ellilä and Mari Lahti

Olasoji Awoyera

TURUN AMMATTIKORKEAKOULU THESIS

The purpose of this study was to review the attitude of nursing students towards people with
disabilities in the western world and compare this with the pilot study from Africa for possibility of
cultural differences and demographical variables.

A systematic review of the previous studies were observed (n=6).The pilot study was conducted
with 60 students in Ghana. A questionnaire (Interaction with Disabled Person Scale) was filled
out by the students and statistical analysis; frequency, percentage, means and standard
deviation were measured.

The findings revealed that the students still had negative attitude towards people with
disabilities even in a different cultural background (74.76 ± 11.22). In the pilot study, no
significant difference was found in age, gender. Slight different in educational level but
significant differences in contact with people with disabilities, how often are they in contact and
to whom do they have contact.

The study showed that there is existence of negative attitude among the nursing students
regardless of cultural background. Further studies should be carried out on this and quick
intervention should be put in place to improve the students’ attitude to meet up with the
continuous growing in the number disabled people.

KEYWORDS:

Disabilities,nursingstudents,attitudes

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CONTENT

LIST OF ABBREVIATIONS 6
1 INTRODUCTION 7
2 BACKGROUND 9
2.1 Disability overview 9
2.2 Attitude overview 10
2.3 Attitude towards people with disabilities 10
2.3.1 Societal Attitude 11
2.3.2 Attitude of Health care professionals 11
2.3.3 Attitude of health care students 12
3 PURPOSE AND AIM 14
4 RESEARCH QUESTIONS 14
5 SYSTEMATIC LITERATURE REVIEW 15
5.1 The method of review 15
5.2 The process of review 15
6 MATERIAL AND METHODS 19
6.1 Pilot Study 19
6.2 Data collection instrument 20
6.3 Data collection 20
6.4 Data analysis 21
7 RESULT OF PILOT STUDY 21
7.1 Demographic description 21
7.2 Interaction with disabled persons scale scores and the variables 25
7.3 Comparison of the means score ,standard deviation and variables 28
8 ETHICAL CONSIDERATIONS 32
9 RELIABILITY AND VALIDITY 32
10 DISCUSSION 33
10.1 Discussion of methodolgy 33
10.2 Discussion of result 33
11 CONCLUSION 36

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APPENDICES

Appendix 1. Searching words

Appendix 2. Permission from Sydney, Australia

Appendix 3. Participation permission

Appendix 4. Interaction with disabled persons scale IDP

Appendix 5. Scoring system of IDP

Appendix 6. Demographic information

FIGURES

Figure 1. Percentage of age 22

Figure 2. Percentage of gender 22

Figure 3. Percentage of college year 23

Figure 4. Percentage of people that had contact with disabled people. 23

Figure 5. Percentage of how often the subjects had contact with the disabled

people. 24

Figure 6. Percentage of whom do they had contact 24

Figure 7. Age and the scores 25

Figure 8. Gender and the scores 26

Figure 9. College year and scores 26

Figure 10. Have you had experiences or contact and the scores 27

Figure 11. How often do you have contact and the scores 27

Figure 12. With whom do they have contact and the scores 28

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TABLES

Table 1. Description of materials 17

Table 2. Mean and standard deviation of the gende 29

Table 3. Mean and standard deviation of the age 29

Table 4. Mean and standard deviation of the college year 29

Table 5. Mean and standard deviation of the Contact with disabled people 30

Table 6. Mean and standard deviation of how often 31

Table 7. Mean and standard deviation of whom do you have most frequent
contact 31

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LIST OF ABBREVIATIONS

ADTP Attitudes Toward Disabled Persons Scale

MCRS Medical Condition Regard Scale

IDP Interaction with Disabled Persons Scale

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1 INTRODUCTION

Today, intellectually, physically, or emotionally disabled individuals comprise a

significant portion of the world population (Sen & Yurtsever 2007, 238). Of the
world’s population of nearly 6.5 billion in 2004, 18.6 million (2.9%) were
severely disabled and another 79.7 million (12.4%) had moderate longterm
disability. Disability prevalences rise strongly with age. (WHO 2004, 33.)

The average global prevalence of moderate and severe disability ranges from
5% in children aged 0–14 years, to 15% in adults aged 15–59 years, and 46%
in adults aged 60 years and older. At all ages, both moderate and severe levels
of disability are higher in low- and middle-income countries than in high-income
countries; they are also higher in Africa than in other low- and middle-income
countries .Older people make up a greater proportion of the population in high-
income countries, but have lower levels of disability than their counterparts in
low- and middle-income countries. Disability is also more common among
children in the low- and middle-income countries. Moderate disability rates are
similar for males and females in high-income countries, but females have
somewhat higher rates of severe disability. In low- and middle income countries,
male and female disability rates are similar, although females aged 15–59 years
tend to have higher levels of moderate disability in Africa, the Eastern
Mediterranean and the Western Pacific. (WHO 2004, 34-35.)

Surveys conducted in all EU member states have shown that about 16% of the
population aged 16-64 has a long standing health problem or disability and that
3.4% has severe health problem. (United States Agency for International
Development 2009.) Biritwum et al., (2001) also reported that prevalence of
disabilities is increasing with age in Ghana.

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As a result of this, health care professionals are greatly needed to provide

services for this growing number of disabled people. A Call to Action was
launched in US to improve the health and wellness status of men,women,and
children with disabilities (Smeltzer 2007,189) .

Many have reported negative experiences in their interactions with health care
providers from all health professions. Collectively, the nursing profession has
been silent in its response to this call. (Smeltzer 2007,189.)

Mantzious et al., (2002,1) complained in Greece ,of communication problems

and poor relationships with health professionals, delays in detection and
treatment, insufficient information, guidance and support, inadequate
specialized holistic care and lack of home care services.

To save the situation, more knowledge is needed about the current status of
attitude of future nurses and factors influencing these attitudes. It has been
observed that this area is avoided by nursing professionals because of their
negative attitude toward people with disabilities (Johnston & Dixon 2006, 1).

This bachelor thesis review the current behavior of the nursing students and
what factors mostly influence their attitude towards disabled people. The review
also involve societal attitudes’ towards individuals with disabilities, attitudes of
other health professional students and health care professionals towards
individuals with disabilities. However, a pilot study was conducted to test for
cultural influence on the attitude with the nursing students (N=60) in Ghana.

This study is very important in the sense that, the results will give information on
the status of students’ attitude towards people with disabilities. Result’s will also
enlighten the educators, health professionals, counselors and work practice
employers to design programs that will improve the attitude of students toward
people with disabilities.

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2 BACKGROUND

2.1 Disability overview

The common view of disability is as tragedy, disgrace, the result of sin, and
God’s punishment. People with disabilities are seen as a burden to others, to
their family, to themselves,and to society. In English they are described as
being an invalid (not a valid person), as being handicapped (implying a beggar
with a cap), or as being disabled (not able). Do these views carry over to the
way people in the helping professions relate to people with disabilities? That is
the interesting question. (Pfeiffer et al. 2004).

Health was defined in the WHO Constitution as ‘‘a state of complete physical,
mental and social wellbeing and not merely the absence of disease or infirmity’’.
More recently, the concept has been extended to include health-related quality
of life. Today, the International classification of impairments, disabilities and
handicaps (ICIDH) provides indicators that allow a more structured approach to
health disorders. (Barbotte et al., 2001,1047.)

There are many definitions of disability and many types of disabling conditions.
In 1980, the World Health Organization (WHO) defined disability as a limitation
in a person’s abilities (eg, mobility, personal care, communication, behavior);
impairment as an alteration in body systems (e.g, neurological, respiratory,
urologic); and handicap as the disadvantages experienced by people in their
environment (e.g, in the workplace, economic sufficiency, and independence).
(Lollar & Crews 2003, 201). In 2001, WHO revised its definitions to change the
focus from a classification system based on consequences of disease to one
that is focused on components of health.
Disability can be classified according to Americans with disabilities Act of 1990 :

Physical disability (e.g Mobility, visual, hearing impairment)

Mental disability (e.g Learning disability, schizophrenia, phobia, neurosis)

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Developmental disability (e.g Dyslexia,down syndrome, ADHD,autism)

Other disabilities (e.g Substance abuse,senility)

Invisible disability (e.g Epilepsy, Asperger syndrome, fibromyalgia).

Models of disability provide a framework for understanding the way in which

people with impairments experience disability. They also provide a reference for
society as laws, regulations and structures are developed that impact on the
lives of disabled people. There are two main models that have influenced
modern thinking about disability: the medical model and the social model.
Medical model or illness approach is based on the view that disability is caused
by disease or trauma and its resolution or solution is intervention provided and
controlled by professionals.The social model view as socially constructed and a
consequence of society’s lack of awareness and concern about those who may
require some modifications to live full,productive lives. (Smeltzer 2007,193).

2.2 Attitude overview

“Attitude is a little thing that makes a big difference”- Winston Churchill ( Died 1965).

Attitudes are likes and dislikes- affinities for or aversions to objects, persons,
groups, situations, or any other identifiable aspects of the environment,including
abstract ideas and social policies (Atkinson et al., 1990, 702.)

Attitude comprise of three components; affective, behavioural and cognitive

(Mishra 2006, 8). Affective is shown by positive or negative emotional
expression towards people,events or object. Behavoural is the tendency to
behave in a particular way towards people,events,actions. And,cognitive refers
to our beliefs formed about the object or person. (Mishra 2006, 9).

2.3 Attitude towards people with disabilities

Historically, people with disabilities have not been treated well by society. Over
centuries they have been the subject of varying degrees of pity, ridicule,
rejection and seclusion as the result of being 'different'. (Linton 1998,34).

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Some societies perceived disability as punishment by the gods while in others

children and adults with disabilities were ostracised, left to die or indeed killed
through fear and ignorance. (Linton 1998,34).

2.3.1 Societal Attitude

Mishra (2006) elaborated the attitude of non-disabled treating the disabled as

different. Mishra reported that they were not included in the competitive cliques
that form among active adolescents.They are treated as an out cast whom
people may like but exclude from their inner circle for sports and leisure
activities.They live with their disabilities in the community but they never fully
accepted by the teen age peers. (Mishra 2006, 2).

Mishra sited an example ``With regard to mentally ill, newspaper headlines in

England in twenty first century have included ‘Nuts to be caged for life by the doctors
(The Sun, December 2000) and “psychos to be locked up for life’ (The Sun, June
2002). The animalistic terms ‘caged’ and ‘locked up’ suggest those concerned are less
than human.``

2.3.2 Attitude of Health care professionals

“Attitudes are more important than facts”- Karl a. Menninger( DIED 1990)

A study completed by Kim et al., (2010) comparing the attitudes toward and
contact with people with disabilities among health care professional, lay
persons, and disabled persons (N=270,141 health care professionals) revealed
that health care professionals as well as lay persons and disabled persons have
negative attitudes toward people with disabilities.

Torbjörn (2010) in his Ph.D thesis‘Not in my backyard’also reported the

existence of negative attitude in sweden among the mental health
professionals.

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Mental health professionals with knowledge also display stigmatizing attitudes,

which implies that they, as well as other citizens, must examine their own moral
attitudes, improve their ability to interact with persons with mental illness and
become more tolerant in order to prevent alienation. (Torbjörn 2010, 4)

Rao et al., (2009) also studied 108 health professionals’ attitude toward people
with mental disabilities. Participants had highly stigmatized attitudes towards
patients from a forensic hospital and those with active substance use disorders.
This suggested that health professionals have stigmatized attitudes towards an
illness such as schizophrenia and this is worse towards patients from a secure
hospital (Rao et al., 2009).

2.3.3 Attitude of health care students

“The only disability in life is a bad attitude”- Scott Hamilton.(Born 1958)

A study on the effect of curriculum change in an undergraduate nursing

curriculum was carried out by Seccombe (2007). A convenience sample of
students completed the attitude towards disabled people (ATDP) questionnaire.
The study showed that there was no statistical significant difference in the
scores prior to and on completion of their relevant disability unit. (Seccombe
2007, 459.)

Research at Michigan state university explored the effect of contact, context,

and social power on undergraduate attitudes toward persons with disabilities.
The authors were of the view that negative perceptions and attitudes toward
persons with disabilities persist. These invisible barriers serve to limit social
interactions with persons with disabilities and fuel the reciprocity of negative
attitudes. Research suggests that social proximity to disability is a major factor
affecting how these attitudes manifest themselves. (Schoen et al., 2009).

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A sample of 218 undergraduate students completed the Attitudes Toward

Disabled Persons Scale (ATDP), a direct measure of attitudes toward people
with disabilities. Study findings suggest that representation of persons with
disabilities in leadership roles in work, education, and other social settings may
promote greater attitudinal shifts toward persons with disabilities than contact
with persons with disabilities in non-authoritarian roles. (Schoen et al., 2009,11.)

Tervo et al., (2004) investigated the health professional student attitudes toward
people with disability. A cross sectional survey of 338 students of university of
South Dakota was carried out, using ATDP scale, SADP and RSI . All students’
attitudes were less positive than SADP norms and nursing students held the
least positive opinions. No attitudinal differences by gender, those with
background in disability had more positive attitude. The author concluded that
nursing undergraduate students were at greater risk of holding negative
attitudes and recommend specific educational experiences to promote more
positive attitudes. (Tervo et al., 2004, 913.)

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3 PURPOSE AND AIM

The purpose of this bachelor thesis is to determine the attitudes of nursing

students toward people with disabilities. And also, to evaluate what influence
the attitude of the future nurses.

This research will be useful in identify factors to be addressed in the training of

health care students. It will also help in identify the attitude of future health
professionals which may hinder the integration and provision of services for
people with disabilities. This will be published in the hoitonetti to enlighten the
educators, health professionals, counselors and work practice employers on
how to further improve the students’ attitude.

4 RESEARCH QUESTIONS

A. What is the attitude of student nurses toward disabled people?

B. What demographic variables (age, gender, level of education, number of

contact or cultural background) mostly influence this attitude?

C. How can the student nurses´ attitude be improved?

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5 SYSTEMATIC LITERATURE REVIEW

5.1 The method of review

Systematic literature (S.R) review will be used for the previous articles.
Systematic review uses existing primary research for secondary data analysis.
In a situation where large volume of data is involved, S. R helps in controlling
the data in a logical way and make use of all the relevant information that
evolved. Most of the time, it is preferable to try S. R for a study before
embarking on a fresh study. (Neale 2009, 63).

There may not be need to conduct a new study anymore. S.R is recommended
before designing a new study because they can identify weaknesses in the
methodology of existing studies and may prevent unnecessary replication.
Systematic literature views systematic review from a very broad angle as a
method with the following features: a clearly defined research question;
transparent methods, defined a priori to include clear criteria for including and
excluding studies; exhaustive searches for published and unpublished studies;
explicit reporting of the methods used to appraise, abstract and synthesize
information from individual studies, conducted in duplicate to minimize errors;
and clear presentation of study findings. (Neale 2009, 65).

5.2 The process of review

The objective of the literature review was to find five to seven research articles
discussing the attitude of nursing students’ toward people with disabilities.The
search for these articles was difficult as very few articles had direct links to free
full text versions. The search took place between September 2010 and April
2011. In the search for the articles three databases were used; Pubmed,
CINAHL (EBSCOhost), Elsevier and manual search. Most of the articles were in
abstract form.The EBSCO was the best of all.The results were limited by the
inclusion and exclusion criteria.

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Inclusion criteria for the articles:

1. They were written in English.

2. They were published in scientific journals between 2000 and 2011.

3. They were based on research studies.

4. They were available in full text form.

5. They were peer reviewed.

Exclusion criteria for the articles:

1. The research which focused only on non-health sciences students.

2. The research which did not include any forms of disabilities.

3. Research which divert from measuring the attitude.

There were several different search terms that were used in hopes of finding
relevant articles. The keywords used to do the search included the following:
disabled, disabilities, student nurses, attitude (see appendix. 1).

The results were too wide and the search criteria had to be further narrowed.
The searches were limited to include only those articles that either provided a
full text version or a link to a full text version.

During the elimination process thousand abstracts were overviewed and then
either eliminated or earmarked as a possibility and returned upon later. In the
end of all the hundreds of articles overviewed only 43 proved to be adequately
linked to the topic and 12 had a link to a full text version. Some of the other
responses were also properly linked to the topic, but did not have a link to a full
text article nor was it possible to find such a link through other search
databases. Others had links to full text articles, but they were not free and they
were purchased via the librarian.

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Best 4 were picked from those with full text while others were eliminated based
on meeting the exclusion criteria and 2 relevant articles were bought to meet
up with the number for review. (See the appendix1/(2) for the flow chat.)

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Table 1. Description of materials

Author(s) Title and year Aim(s) and Research Sample(N) who, Main results Implication and or
purpose method where, when recommendations
collected

Boyle.J Attitudes of Measure the Medical 548 students. Differences between the Better education of
Malcolm et undergraduate attitudes of Condition Monash University. courses. students in students on patient
al. health science undergraduate Regard Scale undergraduate health-related presenting substance
students students (MCRS) Australia courses, as a group, have a abuse.
towards patients enrolled in six strong
with intellectual different health- regard for patients with
disability, related courses intellectual disability and some
substance abuse, regard for patients with acute
and acute mental mental illness, but not for
illness: patients presenting with
a cross-sectional substance abuse problems.
study. 2010
Mantziou,V Attitudes of To examine and Attitudes 99 registered Whole attitude appeared poor. Use of innovative
et al. registered nurses compare the towards nurses,189 student Student nurses had more educational strategies may
and student attitudes of disabled nurses. positive attitude than the have a positive effect on
nurses to disabled nurses and persons’ nurses. Differences between subjects’ attitudes towards
children.2002 student nurses. Scale Greece age groups and students disabled children
(ATDP) educational settings .No
significant differences in
gender.
Klooster Attitudes towards To investigate ATDP-A,SADP 81 Dutch nursing Nursing students were more Educational interventions
Peter M.T people with the attitudes &CLAS-MR students &48 non- positive than their peers. focus on forms of contact
et al. physical or towards people nursing peers. Positive attitude as a result of beyond the context of
intellectual with physical or having a relative or friend with formal care relationships.
disabilities: intellectual Netherland physical disability.
nursing students disabilities.
and non-nursing
peers. 2009

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Table 1. Description of materials (continued).

Tervo Health professional student To investigate health ATDP,SA 338 graduate All students’ attitudes Specific
R.C et attitudes towards professional student DP&RSI &undergraduate were less positive. educational
al. people with disability.2004 attitudes toward students. Nursing student experiences are
people with disability University of held least positive. needed to promote
South Dakota USA No attitudinal difference more positive
in gender. Those with attitudes
disability background
are more positive.

Au KW & Attitudes toward people with To explore the ATDP 511 students and Professionals had a Made to modify the
Man D disabilities: a comparison attitudes of health care 489 professionals significantly higher current training
WK between health care professionals and their attitudinal score than the curriculum and
professionals and students towards Hong Kong students. Their attitudes enhance the quality
students.2006 people in Hong Kong were less positive than of services to
with disabilities those of the student develop more
nurses. Age, year of favorable attitudes
study, educational level, towards people
knowledge and contact with disabilities.
with people with
disabilities were
significant factors in the
attitudes held by the
students and professional
respondents

Matziou Attitudes of nurse To investigate the Attitude 228 nursing Nurses’ attitudes Carefully designed
V. et al professionals and nursing attitudes of nurse Towards students, 90 post- appeared to be poor curricula can
students towards children with professionals Disabled diploma nurses 123 influence the
disabilities. (pediatric nurses) and Person nurse attitudes of nursing
Do nurses really overcome nursing students Scale students towards
children’s physical towards disabled (ATDP). Greece children
and mental handicaps?in_735 children. with disabilities.
45 2009

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The articles reviewed above (see table 1) were published within 2002 to 2010.
All the articles made used of reasonable sample size. Three of the articles
(Mantziou et al., 2002, 2009 & Au & Man, 2006) compared the attitude of
nursing students and the registered nurses, one (Klooster et al., 2009)
compared the student nurses with the non-nursing peers and one article (Tervo
et al., 2004) involved only nursing students. All the research access the attitude
of health care students. The two studies (Mantziou et al., 2002, 2009) focused
on disabled children, one (Boyle et al.,2010) investigate attitude towards
intellectual disability, substance abuse and acute mental illness.

One article (Klooster et al.) measured attitude toward physical or intellectual

disabilities and two (Mantziou et al. & Tervo et al. ) measured general disability.
Five articles (Mantziou et al.,Klooster et al.,Tervo et al., Au & Man) used ADTP
scale, two (Klooster et al. & Tervo et al.) used other scales plus ADTP
(SADP,CLAS-MR &RSI). One article (Boyle et al.,2010) used medical condition
regard scale (MCRS) but all measured the attitude. Demographical variables in
all include age and gender (3), educational level (2) and contact with friends or
relatives (3).

6 MATERIAL AND METHODS

6.1 Pilot Study

Pilot study was used in this Bachelor thesis. Pilot study is a small experimental
designed to test logistics and gather information prior to a larger study, in order
to improve the latter’s quality and efficiency. A pilot study reveal deficiencies in
the design of a proposed experiment or procedure. (Altman et al. 2006, 2.)

In this pilot study nursing students were asked questions related to various
aspects of interactions focusing on discomfort in social interactions, coping
when meeting people with disabilities,information about disability and a person’s
vulnerability.

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6.2 Data collection instrument

A self – report question about attitudes to individuals with disabilities developed

in Australia, Interactions with Disabled person’s scale (IDP) was used to obtain
data (See appendix 4) and a designed demographic information sheet was
used to obtain variables. (See appendix 6).

This is 20-item Likert scale designed to measure attitudes toward people with
disabilities by assessing levels of discomfort in social interactions as a central
factor underlying negative attitudes. (Gething 1992, 10.)

The respondent indicates his or her level of agreement with each of the 20
items on the scale. The response for each item range from I agree very much
(6) to I disagree very much (1). There is no mid- or neutral- point on the scale.
Question No. 19 was discarded as evidence emerged from factor analyses
suggest it does not cluster consistently with other variables on a factor. All
remaining items were add up except (Question 10, 14 and 15). Questions 10,
14 and 15 were scored in reverse, and added to total. This gives a Total scale
score (see the appendix 5 for summary of the scoring system). Higher scores
will indicate greater discomfort in social interactions with people with disabilities.
(Gething 1992, 10.)

6.3 Data collection

The study took place during the three months clinical practice in Ghana (Sept.-
Dec. 2010). Simple random sampling was used by the researcher to efficiently
recruit nursing students for this study and to gain insight into the attitude. First,
second and third year students were asked to complete a paper version of the
Interaction with disabled person scale (IDP) in a classroom setting. After giving
verbal consent, 59 successful completed the demographic information and IDP
scale. One student was unable to complete the question. The demographic
information included questions regarding student status, age, gender, contact,
how often are they in contact and to whom do they have contact.

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6.4 Data analysis

Data analysis was performed using IBM SPSS window (version 19). The
methods of statistical analysis that were used included frequencies, percentage,
means and standard deviations to show the distribution of demographic
characteristics and the questionnaire scores.

7 RESULT OF PILOT STUDY

This pilot study aim to identify the attitudes of nursing students in Ghana in
relation to the existing findings. The total number of sample was sixty with one
missing due to incomplete answer of the scale (N=59). Results are presented in
the following categories: demographic description, IDP scores with the variables
and comparison of the means score with standard deviation classified by age,
gender, college year ,ontact, how often and with whom do you have contact.

7.1 Demographic description

Figure 1. Percentage of age.

Most of the students’ ages were between 21-25 (61.7%); second by the ages
group 17-20(26.7%). Only one subject was over 35 year of age.

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Figure 2. Percentage of gender.

Large group of the studying were female (66.7%) while male were (31.7%).

Figure 3. Percentage of college year.

First year students had the highest percentage(40.0%); this was followed by the
third year (31.7%) and 2nd year (26.7%).

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Figure 4. Percentage of people that had contact with disabled people.

This report showed that 81.7% of the students had contact with people with
disabilities and just 16.7% did not have contact.

Figure 5. Percentage of how often the subjects had contact with the disabled
people.

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31.7% of the students had contact with disabled people less often than once
every 3 months; followed by students that had at least once a month
(21.7%).The least was in students that had contact once in every 3 months.

Figure 6 . Percentage of whom do they had contact.

40.0% of students had contact with someone they see occassionally; 25.0%
contact others.1.7% of the subjects had contact with classmate that were
disabled and 16.7% had contact with patient that were disabled.

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7.2 Interaction with disabled persons scale scores and the variables

Score ; < 55 represent positive attitude, 55-65 represent indifference and >65
represent negative attitude.

Figure 7. Age and the scores.

Most students had scores above 65 (43%) age (21-25); 12% scores mark
between 55-65 and 4% scores less than 55.

Figure 8. Gender and the scores.

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30 female students had scores greater than 65 and 13 male had score above
65. The same number of students male and female scores less than 55.

Figure 9. College year and scores.

Among the college years that score above 65,3 rd year had the highest (N=18)
and the second year had the lowest (N=12). Only 1st year had the lowest score
(N=4).

Figure 10. Have you had experiences or contact and the scores.

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 27

Among the respondents,35 students had contact with the disabled people and
score above 65. Only 4 respondents scores less than 55.

Figure 11. How often do you have contact and the scores.

Respondents that had often less than once every 3 months had the highest
number (N=16) that scores above 65; respondents that also had contact once
every 3 months (N=9) scores well above 65. Only 4 respondents had daily
contact and scores less than 55.

Figure 12. With whom do they have contact and the scores.

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 28

Respondents (N=19) that had contact with someone they see occasionally were
the most among subjects that scores above 65. The same number of
respondents (N=1) scores less than 55 had contact with friend, classmate,
client/patient and someone they see occasionally.

7.3 Comparison of the means score ,standard deviation and variables

The mean score and the standard deviation of all the respondents on this
questionnaire were 74.76 and 11.22 (N=59), suggesting that the respondents
tended to have negative attitudes toward people with disabilities.

Table 2. Mean and standard deviation of the gender.

Gender
Male Female Total
Mean 72,05 76,05 74,76
N 19 40 59
Std. Deviation 11,86 10,81 11,22

Female respondents had mean score of 76.05 (SD=10.81) and the male had
72.05 (SD=11.86).This shows negativity in the gender.

Table 3. Mean and standard deviation of the age.

Age
17-20 21-25 26-30 over 35

Mean 77,06 74,16 72,00 74,00

N 16 37 5 1
Std. Deviation 9,11 11,91 14,26 .

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The mean score of the age group 17-20 had the highest (77.06); and lowest
was found in the age group 26-30 (72.00). This revealed no significant
difference in age group and shows social discomfort.

Table 4. Mean and standard deviation of the college

year

College year
1st yr 2nd yr 3rd yr
Mean 71,12 75,25 78,94
N 24 16 19
Std. Deviation 12,45 9,60 9,70

The third year students had the highest mean score (78.94) and the lowest was
found in the first year (71.12). This college year revealed negativity in social
interaction with disabled people, but there is more difference between the 1st
year and 3rd year students.

Table 5. Mean and standard deviation of the Contact with

disabled people.

Contact with disabled people

Yes No
Mean 73,51 80,90
N 49 10
Std. Deviation 11,06 10,40

The mean score for respondents that had contact was lower (73.51) than the
respondents without contact (80.00). Though this shows negativity but students
that had contact are better.

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Table 6. Mean and standard deviation of how often.

How often

Less often
than once
At least once a Once every 3 every 3
No contact Daily Weekly month months months
Mean 80,90 67,00 67,87 71,15 75,75 78,73
N 10 5 8 13 4 19
Std. Deviation 10,40 10,34 5,93 10,83 5,50 12,07

Respondents that had daily contact had the lowest mean score (67.00); The
mean score of students with no contact was the highest (80.00).

The mean score of respondents that contact disabled classmates was 51.00,
seconded by those that had them as friends (68.00).The highest was found in
students that do not contact any (79.80).

Table 7. Mean and standard deviation of whom do you have most frequent
contact

With whom do you have most frequent contact

Close family Friend Classmat Client/patie Someone I No one

member e nt see
occasionally
Mean 70,66 68,00 51,00 72,70 75,66 79,80
N 3 6 1 10 24 15
Std. 10,01 11,54 . 10,40 10,76 10,22
Deviation

All statistics were calculated with version 19.0 of the SPSS programme. In this
study, there were more female (N=40, 66.7%) more than male (N=19, 31.7%).

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Among the students(N=60), forty percent were first year students. Most of the
students (N=37,61.7%) were between 21-25 years old.

Most of the students in this study (N=49,81.7%) had previous contact with
disabled people (fig.4). According to how often the students had contact,31.7%
had contact less often than once every three months, 21.7% had contact at
least once a month and 16.7% had no contact (fig.5). With whom do they had
contact ,forty percent of the students (N=24) had frequent contact with someone
they see occasionally and 1.7% had contact with their classmate (fig.6). The
scores of IDP scale ranged from 50 to 94 with the overall mean score of 74.76 ±
11.22, which is considered to be negative.

There were no significant differences between the age and gender with the
mean scores of the students(see table 3 and 4). Slight difference was observed
in the college year between the first year and third year students but the range
still indicate negative attitude (71.13-78.95) (Tab.5).

There was differences in the IDP mean scores of students that had previous
contact (73.5) and students without experiences (80.9). Students that contact
disabled people daily shows significant different in the mean score (67.0)
compare to other students (Tab.7). Furthermore, the type of people they had
contact with also show significant differences, classmate (51.0), friend (68.0),
close family (70.7), patient (72.7), someone I see occasionally (75.7) and no
one (79.8). This results supported most of the previous studies that will be
discussed.

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8 ETHICAL CONSIDERATIONS

Written permission was obtained from Sydney, Australia to use the IDP scale.
(See appendix 4). In Ghana, the researcher consulted the school administrator
for advice and it was determined that there was no need for an application to be
made but verbal consent from the clinical instructor was obtained.

Written and verbal information about the study were given to the students and
they were told that their participation in the study was voluntary. (See appendix
3). Further, the answers were anonymous, the students could not be identified
and the results were reported with no possibility for identification of any
students’ data. ( Etene 2002.)

9 RELIABILITY AND VALIDITY

Statistical feature of systematic review (S.R) makes the results of S. R to be

more reliable and valid. It allows possibility of using mathematical approaches
which helps in drawing a significant relationship among the data under study. A
particular advantage of systematic review including a meta-analysis is their
statistical power. (Neale 2009, 67.) In this bachelor thesis, meta-analysis will not
be used but systematic review.

Clearly defined research questions in the beginning of a study give a direction

to the systematic review method. S. R has a logical way of providing answers to
an already set research question; it follows the analysis in a chronological order
till the end and arrives at the answer. It also creates a room for future
modification. Having a clearly defined research question is fundamental to the
success of a systematic review. (Neale 2009, 69.) In this bachelor thesis, the
research questions are clearly stated.

The scale used in the pilot study had been tested and re-tested, found reliable
and valid (Gething 1992, 19).

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10 DISCUSSION

10.1 Discussion of methodolgy

Systematic literature review was used in this study, details about the method is
given in the previous chapter. After gathering the valuable articles, the next line
of action was to analyze the data and make use of them properly.

The pilot study aims to study the attitudes of the nursing students toward people
with disabilities classified by age, gender, educational level, contact, how often ,
to whom do they have contact and to test possibility of cultural inflences. The
samples were 60 nursing students who are currently studying nursing science.
Data was collected in November 2010.There were two instrument used in this
research (1) interaction with disabled persons scale (2) Demographic
questionnaire. Data was analysed by using IBM SPSS version 19.0 for window
to examine the frequency, percentage, mean and standard deviation.

10.2 Discussion of result

This pilot study demonstrates that nursing students are not showing positive
attitude towards people with disabilities despite the cultural difference from the
previous study. Watanabe (2003, 37) studied cross cultural comparison of
attitudes towards person with disabilities using college students in Japan and
United States , reported no significant difference in the attitude scores. On the
contradiction, Grames & Leverentz (2010,1) observed significant differences
among the three disability types. However, the Chinese reported significantly
higher scores on the ATDP scale, which corresponded with more favorable
attitudes toward persons with disabilities.

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Providing answers to the research questions :

1. What is the attitude of the student nurses toward disabled people ?
2. What demographic variables (age,gender,levels of education,number of
contact or cultural backgroud) mostly influence this attitude ?
3. How can the student nurses’ attitude be improved ?

To answer the first question, this pilot study showed the attitude of the student
nurses towards people with disabilities is not positive (Mean score = 74.76 ±
11.22). This is in line with the findings of Mantziou et al. (2002 & 2009) which
highlight the overall the overall negative attitude towards disabled among the
Greek student nurses. Tervo et al. (2004, 908) also reported that nursing
students held the least positive opinion about the disabled among all the health
professional students. Au & Man (2006, 155) found the nursing students to be
in third place among group of four students which showed negative impression.
Klooster et al. (2009, 2562) reported positive attitude, this was compared to the
non-nursing peers. Boyle et al. (2010, 2) also showed that student’s attitude
was positive because of the perceptive of viewing disability as a medical
condition. This form of inconsistency was early reported in many articles and
that is why it called for further research.

To address the second research question, the mean scores of the attitude and
the variables in this pilot study (Tables 2-7) showed differences in the students
that had contact, how often they had contact and with whom they had contact.
There were no significant differences in age and gender but slight different was
noted between the 1st and 3rd college year (Table 4). This is similar to previous
studies. Ouellette et al. (2010, 132) reported that participants who had contact
with family member with intellectual disability showed positive attitude. Stachura
& Garven (2003, 653) and Schafer et al (2010,1) also found that personal
contact with someone with mental illness was a significant factor, the more the
contact students had with disabled people, the more positive their attitude. Most
of the research works do not test for the time of contact and with whom do they
have contact but they suggested it.

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This pilot study revealed that students that had contact daily and weekly had
more positive attitude than students that do not have contact and had contact
less often than once every 3 months (Table 6). This implies that regular
proximity to the disabled people can actually break the barrier of students’
negative behavior.

From the six articles reviewed, there was still different factors considered but
mostly implicated factors were:
1. Gender
2. Educational level
3. Contact with disabled people

The third question investigates the possible ways to improve the student nurses’
attitude. Different articles gave various ways to improve the students’ attitude;
Shakespeare et al. (2009, 1816) suggested that visiting patients in their own
homes enables students to understand disabled people in context and
appreciate what their capabilities are. Shakespeare sited a positive results have
been reported from programmes where pediatrics residents spend time with
families of children with disabilities in their homes. Student nurses need the
skills and knowledge to equip them to provide safe and enabling care for
everyone they encounter, including patients who are in any way ‘different’,
Seccombe (2007, 450) suggested. The six reviewed articles unanimously
agreed on the following ways to improve the attitude:
1. Use of specific and innovative educational strategies.
2. Educational interventions focus on forms of contact beyond the context of
formal care relationships.
3. Long hours work experience with disabled people.

The limitations of this study include different scales used in the reviewed articles
for measurement. In the pilot study, only one school and the number of students
used makes it difficult to generalize the attitude of nursing students in Africa.

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11 CONCLUSION

There is a need for significant changes in the preparation of nursing students to

practice in the 21st century. Seccombe (2007, 450) implicated nursing education
to have a significant role to play in creating a climate of information and
experience that is conducive to and in support of a move from medical model of
practice to embrace the social model if the attitudes of student nurses are to
become more open and accepting of people with disabilities. In the researcher’s
view and experience, having a long hours contact, having disabled persons as a
relative or friends will go a long way to improve the attitude.

The researcher recommend further studies should be carried out to test for the
effect of types and duration of contact. Constant research studies should be
carried out on the nursing students to know their attitude status before complete
degradation.

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Searching words (CINAHL) Appendix 1

Search terms Hits

Attitude,health professional,disabilities 237

attitude 60892

health care professional,student nurses 184819

health care professionals 6070

student nurses 2691

nurses 180150

paraplegia 42520

down's syndrome 1606

epilepsy 564

exceptional 1

handicaps 548

impairment 328

sensory disability 16709

physical disability 27

multiple disability 1084

severe disability 79

intellectual disability 701

intellectual disability 25169

mental disability 0

learning disability 270

emotional disability 1504

behavioral disability 62

disability 20

disabled 25169

disable 39

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FLOW CHART of Review Appendix 1/(2)

Cinahl database Other database

(N = 237) (N = 150)
Identification

Limited to full link to the topic/articles

(N = 110)

Adequate link to the topic Excluded

(N = 29)
(N = 43)
Screening

Eligible by virtue of titles Excluded based on

testing an intervention
(N = 12) (N =6)

No=6

Compose of health care students and Abstract

Eligibility

attitude ,disabilities( N = 6) (N=2)

Final articles selected due to the whole

Included

Bought full articles

text (N = 4)
(N=2)

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PERMISSION FROM SYDNEY,AUSTRALIA APPENDIX 2

13.09.2010

Dear Olasoji

Please find attached a copy of the IDP scale and scoring manual. Also included are a
sample consent form and a sample background demographics page – you will need to
adapt these as required to suit your requirements. Lindsay Gething, who developed the
scale, has retired. The IDP is now free, so there is no charge for its use. Please get
back to me if you have any questions.

Good luck with your research

Cheers

Judith Fethney

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Participation permission APPENDIX 3

Dear Student,

I am a nursing student from Turku University of Applied Sciences, Salo in Finland. I

am working on my bachelor thesis: ´´Attitude of student nurses’ toward people with
disabilities``. I am asking you to take part in a research I am conducting .The aim of
my research is to find out what the attitude of student nurses is and what influence the
student attitude when in contact with disabled people. I hope that the results of this
research will be useful to all the students and help the health professionals/educators
on how to improve the attitude.

This research is conducted as a quantitative and qualitative study. The questionnaire

address questions related to background information and attitude toward people with
disability. The target groups are the future nurses.

I ask you kindly to answer the questions below; it will take about ten minutes. The
information obtained from the questioners will be handled completely in confidence and
anonymously. The finished thesis will be placed for viewing at the library of Turku
University of Applied Sciences Salo Unit. At the request I will also send the finished
thesis to your school.

Lecturers Heikki Ellilä(heikki.ellila@turkuamk.fi) and Mari Lahti(mari.lahti@turkuamk.fi)

will be instructing me on conducting this research.

Thanks you for your participation. If you want further information please contact me.

Olasoji Awoyera
Student in Degree Program in Nursing
Turku University of Applied Sciences
Salo, Finland. SNUS08
E-mail:olasoji.awoyera@students.turkuamk.fi
Phone:+358466699069

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APPENDIX 4

INTERACTION WITH DISABLED PERSONS SCALE

Here is a list of statements that some people have said describe how they feel when they have contact with a person
with a disability. Of course, how we respond to people depends on how well we know them as individuals. However we
would like to know how you feel in general when you meet a person with a disability. Please read each statement
carefully and decide how much it describes how you feel.
Please place one tick next to the question under the column that describes how you feel.
very much

very much
somewhat

somewhat
I disagree

I disagree

I disagree

I agree

I agree

I agree
a little
a little

1 1
It is rewarding when I am able to help

2 It hurts me when they want to do something and can”t 2

3 3
I feel frustrated because I don’t know how to help

Contact with a person with a disability reminds me of my own

4 4
vulnerability

5 I wonder how I would feel if I had this disability 5

6 I feel ignorant about people with disabilities 6

7 I am grateful that I do not have such a burden 7

8 I try to act normally and ignore the disability 8

9 I feel uncomfortable and find it hard to relax 9

10 I am aware of the problems that people with disabilities face 10

11 I can’t help staring at them 11

12 I feel unsure because I don’t know how to behave 12

13 I admire their ability to cope 13

14 I don’t pity them 14

15 After frequent contact, I find I just notice the person not the disability 15

16 I feel overwhelmed with discomfort about my lack of disability 16

17 I am afraid to look at the person straight in the face 17

I tend to make contacts only brief and finish them as quickly as

18 18
possible

I feel better with people with disabilities after I have discussed their
19 19
disability with them

20 I dread the thought that I could eventually end up like them 20

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Appendix 5

The scoring system of IDP Scale

TURKU UNIVERSITY OF APPLIED SCIENCES THESIS | Olasoji Awoyera

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Appendix 6

DEMOGRAPHIC INFORMATION

The following information is required to

assist in describing the sample of people
who have taken part in this project. For
each question, mark only one option.

9. Have you had experiences or contact with

1. Age
people with disabilities?
17-20 ---
Yes----
21-25 ---
No----
26-30 ---
31-35 ---
If yes, how often?
Over 35 ---
Daily ------
Weekly----
At least once a month-----
2. Gender Once every 3 months-----
Male--- Less often than once every 3 months----
Female---

10. In terms of your contact with people with

3. Nationality
disability, with whom do you have the most
Finnish---
frequent contact?
Ghanaian---
Others---
Close family member---
Specify--------
Friend-----
Classmate-------
4. Religion
Client/Patient-------
Christian---
Someone I see occasionally-----
Islam -------
No one-----------
Buddhism—
Atheist -----
Other------

5. Marital Status
Single---
Married----
Widow-----
Widower---

6. College Year
1st year----
2nd year----
3rd year----
4th year----

7. College Major
Diploma---
B.Sc General Nursing---
Public health nursing----

8. Do you have disability?

I have a disability-----
I do not have a disability----

TURKU UNIVERSITY OF APPLIED SCIENCES THESIS | Olasoji Awoyera