Mental health nurses' attitudes towards the physical health care of people with severe and enduring mental illness: the development of a measurement tool

Background: It is well established that people with schizophrenia and related serious mental illnesses die prematurely and have significantly higher medical co-morbidity compared with the general population. Mental health nurses have a key role in improving the physical health of patients but their attitudes to this aspect of their role have not been systematically examined.

Objectives: To develop and validate a measure of mental nurses' attitudes towards physical health care.

Design: The measurement tool was developed from a literature review, focus groups and responses to a postal questionnaire.

Participants and setting: All registered nursing staff working within a NHS mental health trust in the UK were sent the questionnaire and 585 (52%) staff responded.

Methods: Completed questionnaires were analysed by standard descriptive statistical methods. Exploratory factor analysis (principal component analysis) was used to examine and reduce attitude items to a coherent and parsimonious scale.

Results: A 28-item measure comprised of four factors accounted for 42% of the variance. The factor solution appeared to provide meaningful dimensions, and the internal consistency of the measure and of its derived subscales was adequate (Cronbach's alpha between 0.76 and 0.61). The factors were labelled nurses' attitudes to involvement in physical health care; nurses' confidence in delivering physical health care; perceived barriers to physical health care delivery and nurses' attitudes to smoking. Validity was established by associations between the total scale and subscales with pre-determined respondent variables.

Conclusion: The Physical Health Attitude Scale for mental health nurses (PHASe) is a first attempt to develop a valid and reliable measure of this important area. The initial development methods and its testing in a large sample provide indications of content and construct validity. Further testing in different samples and consequent refinement are necessary, however the PHASe appears to be a useful tool for measuring attitudes among this professional group and evaluating the effects of professional development.