A study of emotional attitude of psychiatric nurses: reliability and validity of the Nurse Attitude Scale.

In psychiatric nursing, the exchange of feelings among nurses and patients is vital. However, expressed emotion (EE) studies that have been performed in family studies of schizophrenia indicate that a high EE score can predict the relapse of schizophrenic patients. In the case of long-term inpatients at a psychiatric hospital in Japan, the emotional attitude of nurses towards patients is anticipated to have some effect on the course of the illness. In the present study, we revised part of the phrasing of the Japanese version of the Family Attitude Scale, and renamed it the Nurse Attitude Scale (NAS). We tested 189 nurses with this scale, and examined reliability and validity. In a factor analysis of the NAS, three factors were extracted, which we termed criticism, hostility, and positive remarks. These factors are the same as items for assessment on the Camberwell Family Interview, a method of EE assessment. Cronbach's alpha for individual subscales was 0.848 for criticism, 0.845 for hostility, and 0.685 for positive remarks. With regard to test-retest reliability, there were significant correlations with values of 0.65 for criticism, 0.77 for hostility, and 0.44 for positive remarks. In addition, there was a significant correlation between the NAS and Pines' Burnout scores. These facts, thus suggested that the NAS represents an approximation of the EE of psychiatric nurses. In addition, these findings indicated that the state of burnout in psychiatric nurses resulted in a critical attitude towards patients.