Munro Alison, Watson H E, McFadyen Angus
School of Nursing, Midwifery and Community Health, Glasgow Caledonian University, Cowcaddens Rd, Glasgow G4 0BA, UK.
Int J Nurs Stud. 2007 Nov;44(8):1430-8. doi: 10.1016/j.ijnurstu.2006.07.024. Epub 2006 Sep 22.
Substance misuse can trigger or be causally associated with mental health problems. Therapeutic attitude is important in predicting effective engagement with people with alcohol and drug problems but health professionals' attitudes towards this client group are often negative. Education regarding substance misuse has often been neglected and nurses may lack knowledge to provide appropriate care.
To test the impact of training for staff who work with people who have co-existing mental health and substance use problems.
A randomised controlled trial.
An NHS Primary Care Division in the West of Scotland.
Forty-nine mental health nurses.
Intervention. A four-day training programme.
(a) therapeutic attitudes measured by the co-morbidity problems perceptions questionnaire; (b) knowledge of alcohol, drugs and co-morbidity measured by a structured questionnaire.
Significant effects for group (F=30.42, p<0.001) were found in therapeutic attitude scores and also over time (F=10.66, p<0.001). A significant interaction was also found (p<0.001). Post-hoc testing revealed that the mean pre-training attitude score was significantly different from post-training (p=0.001; 95% CI 5.53, 25.38) and from six-months follow-up (p<0.001; 95% CI 11.26, 32.49) but that post-training and follow-up mean scores were not significantly different (p=0.358; 95% CI -4.71, 17.55). For knowledge, a significant group effect was found (F=10.32, p=0.002), and also a significant time effect (F=3.35, p=0.039) but no significant interaction effect was present (p=0.169). The post-hoc testing revealed that only a pre-training to six-month follow-up time effect was statistically significant (p=0.005; 95% CI 1.37, 9.29).
The training programme was effective in improving the therapeutic attitudes of participants to working with clients who have co-existing mental health and substance use problems, both immediately after the training was delivered, and at six-months follow-up. It was also effective in improving participants' overall knowledge of alcohol, drugs and co-morbidity.
物质滥用可引发心理健康问题或与之存在因果关联。治疗态度对于预测能否有效地与酒精和药物问题患者建立联系很重要，但卫生专业人员对该客户群体的态度往往是负面的。关于物质滥用的教育常常被忽视，护士可能缺乏提供适当护理的知识。
测试针对同时患有心理健康和物质使用问题的患者的工作人员培训的效果。
一项随机对照试验。
苏格兰西部的一个国民保健服务初级保健部门。
49名心理健康护士。
干预措施为一个为期四天的培训项目。
（a）通过共病问题认知问卷测量治疗态度；（b）通过结构化问卷测量对酒精、药物和共病的知识。
在治疗态度得分方面发现了显著的组间效应（F = 30.42，p < 0.001），并且随着时间推移也有显著效应（F = 10.66，p < 0.001）。还发现了显著的交互作用（p < 0.001）。事后检验显示，培训前的平均态度得分与培训后显著不同（p = 0.001；95%置信区间5.53，25.38），与六个月随访时也显著不同（p < 0.001；95%置信区间11.26，32.49），但培训后和随访时的平均得分没有显著差异（p = 0.358；95%置信区间 -4.71，17.55）。对于知识，发现了显著的组间效应（F = 10.32，p = 0.002），以及显著的时间效应（F = 3.35，p = 0.039），但没有显著的交互作用效应（p = 0.169）。事后检验显示，只有培训前到六个月随访的时间效应具有统计学意义（p = 0.005；95%置信区间1.37，9.29）。
该培训项目在培训结束后即刻以及六个月随访时，均有效地改善了参与者对与同时患有心理健康和物质使用问题的患者合作的治疗态度。它在提高参与者对酒精、药物和共病的总体知识方面也很有效。
