Attitudes are a complex psychological
construct that over time has received a lot of attention from researchers. An
attitude is defined as a person’s state of mind regarding a person, object or
place that has an influence on the individual’s thoughts and behaviour. It is
acquired through one’s personal experiences and is seen as a “set of beliefs,
feelings and behavioural tendencies towards socially significant objects,
groups or events” (Hogg and Vaughan, 2005). Studies have looked at how staff
working in psychiatric units care for patients with challenging behaviours,
such as patients diagnosed with a Personality Disorder. Looking at staff attitudes
and how they perceive the patients might contribute or affect the way they care
for them. This is one important reason why researchers want to explore this
topic in more depth. Bowers et al. (2006) suggested that people within psychiatric
professions have negative attitudes towards patients diagnosed with a Personality
Disorder. There are different reasons to explain those negative attitudes such
as patient’s diagnosis and them being perceived as manipulative and controlling
but also not engaging with staff. Ganong et al. (1987) was looking at nursing
staff attitudes working with patients diagnosed with a Personality Disorder (hereafter
PD) and they perceived the staff to be more judgemental and had more negative
attitudes about the patients. Another aspect that lead to those negative
attitudes was that some of the patients were self-harming.

Lewis and Appleby (1988)
have found that not only the nursing staff have negative attitudes about working
with PD patients. They also found that psychiatrists had a negative attitude
towards patients diagnosed with a PD and found them more difficult than other
patients. Seeing that represents an issue amongst staff in psychiatric units,
it was suggested that this problem should be addressed by therapists and other
qualified staff to work together with the team in order to change this.

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Bowers (2002) was looking
at nursing staff attitudes from three High Secure Psychiatric Hospitals, their
views and opinions on working with PD patients. Interviews were used to collect
data and content analysis was used to analyse it. During the interviews the PD
topic was discussed and it has been found that the organisation was a factor
that contributed to their attitudes, more specific the way the complaints were
resolved in the unit but also the management. Another factor that influenced
staff attitudes was individual differences, their views and beliefs of PD.
Different aspects, such as moral commitment and their professionalism, and also
staff emotional reactions, have been found to have an impact on patients and
their engagement with staff. The participants who seemed to have a positive
attitude highlighted key aspects such as developing relationships with the
patients and gaining their trust, which made easier deescalating their
challenging behaviours. Therefore, the staff with positive attitudes, were more
respectful and patient in their approach with PD patients. On the other hand,
nursing staff with negative attitudes were more disrespectful and authoritarian
in their approach with PD patients, and were observed to lose their temper

Bowers (2003, as cited in
Bowers et al., 2006) conducted a similar study looking at Prison Officer’s
attitudes working with Personality Disorder prisoners in a Dangerous and Severe
Personality Disorder Unit (DSPD) at HMP Frankland. The participants were
interviewed, and their attitudes were measured over a period of time to monitor
any changes. The study found that staff attitudes were dependent on their
general health, burnout, job performance and their perception of managers. In
the end, the study showed that staff attitudes remains stable over that period
of time and their attitudes were found to remain positive towards working with PD
prisoners. Some examples of the positive attitudes that the prison officers
could have expressed were feelings optimism about the treatment the prisoners
were receiving as well as demonstrating an interest in the prisoners themselves
by voluntarily investing time and effort into interacting with them.

Bowers (2003) in the same
study made a comparison between the Prison Officer’s attitudes and those nurses
attitudes from the previous study, who had negative attitudes. Although, nurses
had more negative attitudes they were found to feel concerned about caring for
the patients, but also found it difficult to manage their behaviour, making
them feel vulnerable and less accepting towards PD patients (Bowers, 2002). It
has been suggested that staff previous experience of working with PD patients
and their cultural view are possible influences on staff attitudes. Therefore,
a greater understanding of PD brought an improvement in patient’s behaviour.
This also shows that staff with a higher level of education, and more knowledge
of PD results in more positive attitudes in working with PD patients. Another
key aspect was the support the staff received from their team, together with
their skills contributing to staff positive attitudes. Whereas, those with
negative attitudes reported to have a lack of information and feedback from
their colleagues which made them feel frustrated, but also less secure in the
environment working with PD patients (Bowers et al., 2003).

In order to look at how
nursing staff attitudes can affect the patients diagnosed with a PD and their
relationship further research is required. This piece of research will
investigate whether nursing staff demographic information (such as their age,
gender, years of experience in general nursing and mental health units, and
their ethnicity) will have an influence on their attitudes working with PD
patients. The study will use a quantitative approach, and data will be gathered
using the Attitudes to Personality Disorder Questionnaire (APDQ). The scores
obtained by completing the APDQ will show whether the participants have
positive or negative attitudes working with PD patients, in Acute Psychiatric
Wards across the Bedfordshire area.  

The aim of the study is
to investigate whether there is a correlation between the scores obtained on
Attitudes to Personality Disorder Questionnaire (APDQ) and variables such as
age, gender, ethnicity and years of experience of the nursing staff. It is
hypothesised to find a significant positive correlation between nurse’s
attitudes working with PD patients in acute psychiatric wards and their
demographic information (age, gender, ethnicity and years of experience).


of the proposed study


The study will have a correlational
design and a validated questionnaire will be used which was developed to
measure clinicians global attitudes towards PD patients (APDQ) (Bowers et al.,
2000). The independent variable is staff age, gender, ethnicity and years of experience
which will be find by completing the Participant Information Sheet.

The dependent variable
will constitute of nurses attitudes which will be measured using the scores
achieved by completing the APDQ and may appear either positive or negative.


The participants who will
take part in the study will be nursing staff from acute psychiatric wards from
Bedfordshire area.


The materials used in order
to conduct the study were a Participant Information Sheet, Participant Consent
Form and Attitudes to Personality Disorder Questionnaire (APDQ). The
Participant Information Sheet will be used to gather general information about participants’
socio-demographics, their age, gender, educational background and years of
experience in both general health services and Mental Health and also their
ethnicity.  APDQ is a 35 item
questionnaire including statements about staff feelings towards PD patients.
Some examples of statements would be “I like PD patients”, ” I feel frightened
in relation to PD patients”, questions with a close-ended answer, fixed
response on a 5 point Likert-type scale, ranging from always, most of the time,
half of the time, a few times, never. The questionnaire has a total of five
subscales that are measured by the total scores. The first scale is looking at
feelings of warmth and enjoyment in working with the patients, scale called
enjoyment/loathing. The second scale is looking at how safe staff is feeling
working with PD patients, their anxieties and fears in relation with them,
security/vulnerability scale. The third scale called acceptance/rejection is
focusing on feelings of anger towards PD patients and seeing them as different
of the rest of the people. The forth scale looks at staff optimism/pessimism
regarding outcome, scale called purpose/futility. The last scale, fifth, called
exhaustion/ enthusiasm focuses on the amount of effort the staff puts on
working with the PD patients. The Participant Consent Form includes information
about the study the participants will take part in and also informs them about
the right to withdraw at any time from the study and all the information they
provide is confidential and anonymous.





The participants who will
take part in the study will be provided with a Participant Information Sheet, a
Participant Consent Form, and a questionnaire. They will be informed about the
study they will be taking part in and they will be made aware that they can
withdraw from the study at any time. They will also be informed that their
answers will be anonymous. After all the information about the study will be
given, the researcher will answer participant’s questions (if they have any),
and they will be reassured about the confidentiality and terms of the study.
They will be asked to complete the Participant Information Sheet with all the
details and sign the Participant Consent Form with the terms and conditions of
the study. After reading the participant consent form they will be asked to sign
to indicate that they understand all the information provided about the purpose
of the study and confidentiality, and any questions regarding it will be
answered by the researcher. Once all this will be done the participants will be
able to start completing the questionnaire and at the end they will be thanked
for taking part in the study.