Effectiveness of Continuing Nursing Education Program in Child Psychiatry

Journal of Child and Adolescent Psychiatric Nursing, Feb 2006 by Chakraborty, Nirmalya, Sinha, Baxi Neeraj Prasad, Nizamie, S Haque, Sinha, Vinod Kumar, Et al

PROBLEM: Program evaluation of the effectiveness of two continuing nursing education programs (CNE) in child psychiatry in India.

METHODS: Pre- and postevaluation of a total of 51 nurses attending a 10-day CNE program, using a 30-item (six-domain) questionnaire according to CNE topics in child psychiatry.

FINDINGS: The CNE program resulted in significant increase in the total scores as well as scores in several sub-domains in the field of child psychiatry.

CONCLUSIONS: In a country that does not offer degree programs that integrate psychiatric nursing into the curriculum, CNE programs are an important educational option for nurses. The CNE program offered in this study, comprising lectures, discussion, interactive sessions, and case demonstrations totaling 60 hr across 10 days, was effective in improving the level of knowledge of nurses. It was equally beneficial for senior as well as less experienced nurses.

Search terms: Child psychiatry, nursing, continuing education, efficacy of psychiatric nursing education in India

Psychiatric illnesses have been a neglected area in the medical field in India and child psychiatry even more so. However, it is very important to be aware of the childhood psychiatric problems in order to identify them early, so that suitable interventions can be started in the early stage of the disorder (Indian Council of Medical Research, 2001). It is estimated that there are about 350 million children and adolescents in India, which comprise about one-third of the entire population (Census of India, 2001), 7-30% of these having various childhood psychiatric disorders (Malhotra, 2002).

In India, child mental health services were started about four decades ago (Shah & Sheth, 1998). The National Policy for Children (1974) was the first long-term step in India for the preventive and promotive aspects of child health care, especially for preschool children, and for the education for other groups of children. National children's boards were established at the center and state levels for planning, review, and coordination of all essential services. Integrated Education for Disabled Children (1974) was started to integrate the physically and mentally handicapped children in the community and to provide educational opportunities for disabled children in school. The National Mental Health Program for India (1982) aimed to provide treatment, rehabilitation, and prevention of illness for adults and children. The school mental health programs (SMH) in India were initiated primarily by nongovernment organizations, with technical support from premier postgraduate training institutes (Kapur, 1997). Structured SMH programs are also being carried out through tertiary psychiatry institutions (Sinha, Thomas, & Thakur, 2003). The National Policy on Education (1986) was declared for early childhood care and education with a comprehensive framework. The policy aimed at free as well as compulsory education up to 14 years of age.

The magnitude of the problem of childhood psychiatric disorders in the developing countries like India can be gauged by the results of a multicentric World Health Organization (WHO)-sponsored study of childhood mental disorders in primary health care in four developing countries, where Giel et al. (1981) have reported that 12-29% of children attending a primary healthcare facility in Columbia, India, Senegal, and Sudan had identifiable psychiatric disorders. It is even more alarming that out of these, 80-90% were consistently missed, or in other words, they did not receive adequate psychiatric help because of lack of recognition and knowledge. Various studies in the epidemiology of childhood psychiatric disorders in India also point toward a similar direction. The prevalence of psychiatric disorders in children is 33.7%, whereas the common disorders seen were: enuresis (14.3%), conduct disorder (11.1%), mental retardation (2.9%), and hyperkinetic syndrome (1.7%) (Deivasigamani, 1990). Based on epidemiological studies carried out in different parts of India, the prevalence of various psychiatric disorders among children is as follows: learning or scholastic problems, 10% (Shenoy & Kapoor, 1996); attention deficit hyperactivity disorder (ADHD), 3% (Mishra & Sinha, 2001); and depressive disorders, 3.13% (Sarkar & Sinha, 2004).

The first child guidance clinic in India was started in 1937, and 120 child guidance clinics are functional in India presently (Kapur, 1995). It has been observed that overall, there is a lack of well-qualified, trained staff in India to cater to the needs of children suffering from various childhood psychiatric disorders (Shah & Sheth, 1998). Overall, in India there remains a shortage of trained psychiatric personnel, especially nurses. Regarding children suffering from psychiatric illnesses, nursing care is quite demanding and requires specialized knowledge. The special role of professional nurses in child psychiatry has also been acknowledged by others (Walshe-Brennan, 1997). However, specialized training for nurses in child psychiatry as structured regular courses is nonexistent.