Attitudes and Emotional Responses of the Nurses in Jordanian Public Hospitals toward Caring for Patients with Disabilities

The study aimed to investigate the attitudes and emotional responses of the nurses in 3 Jordanian Public hospitals for patients caring for patients with disabilities. To achieve the aim of the study a sample was taken from 3 public hospitals in Jordan. Data were analyzed. Results indelicate no correlation between demographic variables and the attitudes and emotions, However there was correlation between attitudes and emotions toward nursing individuals at (p <0.05), But analyzing the correlation between demographic variables and the items of the attitudes scale and emotions shows some correlation individually. Abbreviations: ID: Intellectual Disability; SADP: Scale of Attitudes toward Disabled Persons; ATDP-B: Attitudes towards Disabled Persons Scale ISSN: 2637-6695 DOI: 10.32474/LOJNHC.2018.01.000105 LOJ Nur Heal Car Copyrights@ Maziad A Al K Al A. Citation: Maziad A Al K Al A. Attitudes and Emotional Responses of the Nurses in Jordanian Public Hospitals toward Caring for Patients with Disabilities. LOJ Nur Heal Car 1(1)2018. LOJNHC.MS.ID.000105. DOI: 10.32474/LOJNHC.2018.01.000105. 27 nursing time, training and skills. In particular, it has been noted that nursing staff reported patient with (ID) would be more likely to be segregated and placed in a side room, would be difficult to nurse, more emotional, easily distressed, aggressive and less co-operative. Nursing staff reported that they would be more likely to avoid caring invasive procedures with these patients and be more likely to ask patient care giver to remain on the ward to help out with personal care. In addition, nurses reported that they would be less likely to spend more time explaining treatment, plan to patients with ID, or ask them if they were in pain. Furthermore, nursing staff were more likely to report that their skills and training were insufficient to cater for the needs of patients with ID. Unexpectedly, nursing staffs reported that a patient with ID would be more likely to experience discomfort in the same way as other patients. It is suggested that these findings may be due to participants’ beliefs regarding the different neurological experiences of the individuals with physical disability [9]. Another study suggested that the attitudes of the nurses toward people with ID are less positive than the attitudes toward people with physical disabilities [10]. Also the attitudes of nursing students versus their peers of non-nursing were studied [11]. Results revealed more positive attitudes among nursing students towards physically impaired than the nonnursing peers and more strongly endorsed empowerment and similarly of ID people. In 2005, the US Surgeon General issued a Call to Action to Improve the Health and Wellness of Persons with Disabilities, with the goal being the improvement of the health status of men, women, and children with disabilities. Despite federal legislation to address inequities in health care for the 54-60 million people in the US with disabilities, many have reported negative experiences in their interactions with health care providers from all health professions. Collectively, the nursing profession has been silent in its response to this call. This article describes the current status of health care of individuals with disabilities in the US, and suggests appropriate responses by the nursing profession to the Surgeon General’s Call to Action. Specific suggestions are identified for nursing practice, education, research, nursing leaderships, and the profession of nursing as a whole [12]. A study was conducted to show a strong correlation between general practitioners, self-reported attitudes and emotional reaction to working with patients who have learning disabilities (LD) [13]. It has been suggested that inequalities in health care for patients with (LD) may be party explained by negative attitudes of health professionals. Also a study [14] reported that nursing staff shows less positive attitudes, more negative emotion and fewer positive emotions, in response to care patients with (ID) compared with patients with physical disabilities. Occupation status (registered general nurse, student nurse, nursing assistant) had no effect upon respondents. Also the study reported attitudes or emotions; variables were significantly correlated, with positive emotion being associated with more favorable attitudes. A study addressed by Peter [15] aimed at studying the attitudes of Dutch nursing students towards people with physical or intellectual disabilities. The sample of the study consists of Dutch nursing students (n=81), and agematched group of non–nursing peer (n=48) completed standardized scales measuring attitudes about physically or intellectually disabled people. Nursing students were more strongly empowered and similarity of intellectually disabled people. These attitudinal differences generally remained statistically significant after multivariate adjustment for demographic variables, experience and contact with individuals with disabilities. An important independent determinant of positive attitude toward physically disabled people in the total sample was having a relative or friend with a physically disability. This association however, won’t apparent in attitudes towards intellectually disabled persons. A study presented by Mc Mahon [16] addressed on 214 nurses from Island of Jersy. Results indicated that mental health nurses have more positive attitudes than generic nurses the knowledge of rights, interaction and discomfort components. Also learning disability nurses have significantly more positive attitudes towards the discomfort factor. However there is no difference between the nurse attitudes towards the knowledge of capacity of intellectual disability component and each nursing group knowledge in this area. Dorji [17] studied the attitudes of health professionals toward persons with disability in Bhutan. Research result illustrated that physicians held significantly more positive attitudes than nurses on total of Scale of Attitudes toward Disabled persons (SADP). And the optimismhuman rights subscale (p<.01). In this study Bhutanese physicians and nurses appear to hold less positive attitudes toward persons with disabilities than their counterparts from western countries. The attitudes of nursing students toward children with disabilities were studied by Cervasio [18]. The result of this study suggested that there is a significant difference in means of the Attitudes towards Disabled Persons Scale (ATDP-B) measurements between the groups of the study which indicates the graduating nurses who received disability education performed significantly better on an assessment of attitudes toward children disabilities than those who did not receive the education. A study conduct by Matziou [19] on paediatric nurses and nursing students toward disabled children attitudes .The overall nursing attitudes appeared to be poor, however the graduate nursing had significantly higher. In the study the female nurses hold significantly higher positive attitudes but the age didn’t have any significant effect than male. Another study explored the Knowledge and attitudes of nurse in Jordan dealing with patients having HIV/AID, particularly in regards to their information and education. The results shows all negative attitudes toward delivering nursing care ( 96.22%) ranked fear of getting AIDs from their nursing practice Hassan [20]. A study conducted to explore the attitudes of health care professionals (489) teachers and their students (511) towards LOJ Nur Heal Car Copyrights@ Maziad A Al K Al A. Citation: Maziad A Al K Al A. Attitudes and Emotional Responses of the Nurses in Jordanian Public Hospitals toward Caring for Patients with Disabilities. LOJ Nur Heal Car 1(1)2018. LOJNHC.MS.ID.000105. DOI: 10.32474/LOJNHC.2018.01.000105. 28 people with disabilities in Hong Kong. The attitudes of four groups of professionals and students were assessed by using The Attitude toward disabled persons scale (ATDPS). Comparisons were made among different groups of students and professionals. Results indicated that the overall Mean Attitude toward disabled person scale (ATDPS) of the respondents was comparatively lower than that of their counterparts in other countries. The professionals had had significantly higher score than that of the students. Among the four disciplines, nurses held the least favorable attitudes towards people with disabilities. In addition, their attitudes were less positive than those of student nurses. On the other hand, the social worker students had less favorable attitudes than the professional social workers, as well as other types of health care students. The analysis of the data also revealed that the mean (ATDPS) scale scores for both the occupational therapists and occupational therapy students were above the overall average. Unlike the physiotherapists, the Mean (ATDPS) score of the physiotherapist students was below the overall average. In addition, age, year of study, educational level, knowledge and contact with people with disabilities were significant factors in the attitudes held by the students and professionals’ respondents. The quality of the contact was found to be a dominant factor in affecting the scores on attitude. Thus, recommendations were made to modify the current training curriculum and enhance the quality of services to develop more favorable attitudes towards people with disabilities’ Boye MJ [21]. Attitudes of undergraduate students enrolled in six different health related courses at Monash University towards patients with Intellectual disability, substance abuse and acute mental illness. The results indicated statistically significant differences were found between the courses (p=0.05), year of the course (p=0.09), and gender (p=0.04) for the medical condition of intellectual disability. There was no statistically significant difference between the courses, year of the course, gende


Introduction
The individuals with disabilities have a high rate of unmet health needs and face many disadvantages with regards to the accessing mainstream health care services [1][2][3]. Improving the health of people with disabilities has been a key priority of the government within the world states, as well as Jordan and recommendation to tackle this issue .This has been delineated in many international and national documents [4,5]. Studies investigating the treatment of individuals with disability in general hospital reported that patients and their caregivers are dissatisfied with many aspects of the care they received. The presence of negative attitudes toward the individuals with disabilities leads to exclusion, discrimination and inequality in many areas of life [6]. That is, the researchers have suggested that this may partly explained inequalities in providing health care for this group of individuals.
Recent studies investigating the barriers to health care for people with disabilities have focused upon the views of general practitioners and provision of primary care services [7].There was a lack of studies exploring the views of health professionals working in general hospitals. Nursing staff comprises the majority of health team members in general hospitals and they spend most of the time caring these patients. It is argued that attitudes of nurses towards caring the patients with disabilities are very important, given the potential for negative perception to affect the quality of care delivered. Indeed researchers have acknowledged link between the qualities of care received by certain patients groups, such as mentally ill; HIV/AIDs, elderly physically and mentally impaired [8].
Nowadays, only a small number of studies have sought to investigate the attitudes of nurses towards people with disabilities. Undertook a questionnaire survey in South Birmingham to measure and compare the attitudes and emotions reaction of nursing staff towards patients with intellectual disability (ID) in general hospital setting. The nursing staff who responded to attitude scale consisted of 20 items, represents eight topics ( i.e segregation, nursing task, communication, behavior, nursing time, training and skills, help from careers/relative and experience of pain) and emotional scale which include 10 questions represented two parts, positive and negative emotion. Also the respondents were asked to indicate their age, gender and occupational status. The findings of the study indicated that nursing staff held significantly less positive attitudes in relation to caring the patients with intellectual disabilities (ID) compared with patients with physical disability. However, less positive attitudes were found in seven broad areas which included segregation; carry out nursing tasks, communication and behavior, nursing time, training and skills. In particular, it has been noted that nursing staff reported patient with (ID) would be more likely to be segregated and placed in a side room, would be difficult to nurse, more emotional, easily distressed, aggressive and less co-operative.
Nursing staff reported that they would be more likely to avoid caring invasive procedures with these patients and be more likely to ask patient care giver to remain on the ward to help out with personal care. In addition, nurses reported that they would be less likely to spend more time explaining treatment, plan to patients with ID, or ask them if they were in pain. Furthermore, nursing staff were more likely to report that their skills and training were insufficient to cater for the needs of patients with ID. Unexpectedly, nursing staffs reported that a patient with ID would be more likely to experience discomfort in the same way as other patients. It is suggested that these findings may be due to participants' beliefs regarding the different neurological experiences of the individuals with physical disability [9].
Another study suggested that the attitudes of the nurses toward people with ID are less positive than the attitudes toward people with physical disabilities [10]. Also the attitudes of nursing students versus their peers of non-nursing were studied [11]. Results revealed more positive attitudes among nursing students towards physically impaired than the non-nursing peers and more strongly endorsed empowerment and similarly of ID people. In 2005, the US Surgeon General issued a Call to Action to Improve the Health and Wellness of Persons with Disabilities, with the goal being the improvement of the health status of men, women, and children with disabilities. Despite federal legislation to address inequities in health care for the 54-60 million people in the US with disabilities, many have reported negative experiences in their interactions with health care providers from all health professions. Collectively, the nursing profession has been silent in its response to this call. This article describes the current status of health care of individuals with disabilities in the US, and suggests appropriate responses by the nursing profession to the Surgeon General's Call to Action. Specific suggestions are identified for nursing practice, education, research, nursing leaderships, and the profession of nursing as a whole [12].
A study was conducted to show a strong correlation between general practitioners, self-reported attitudes and emotional reaction to working with patients who have learning disabilities (LD) [13]. It has been suggested that inequalities in health care for patients with (LD) may be party explained by negative attitudes of health professionals. Also a study [14] reported that nursing staff shows less positive attitudes, more negative emotion and fewer positive emotions, in response to care patients with (ID) compared with patients with physical disabilities. Occupation status (registered general nurse, student nurse, nursing assistant) had no effect upon respondents. Also the study reported attitudes or emotions; variables were significantly correlated, with positive emotion being associated with more favorable attitudes.
A study addressed by Peter [15] aimed at studying the attitudes of Dutch nursing students towards people with physical or intellectual disabilities. The sample of the study consists of Dutch nursing students (n=81), and age-matched group of non-nursing peer (n=48) completed standardized scales measuring attitudes about physically or intellectually disabled people. Nursing students were more strongly empowered and similarity of intellectually disabled people. These attitudinal differences generally remained statistically significant after multivariate adjustment for demographic variables, experience and contact with individuals with disabilities. An important independent determinant of positive attitude toward physically disabled people in the total sample was having a relative or friend with a physically disability. This association however, won't apparent in attitudes towards intellectually disabled persons.
A study presented by Mc Mahon [16] addressed on 214 nurses from Island of Jersy. Results indicated that mental health nurses have more positive attitudes than generic nurses the knowledge of rights, interaction and discomfort components. Also learning disability nurses have significantly more positive attitudes towards the discomfort factor. However there is no difference between the nurse attitudes towards the knowledge of capacity of intellectual disability component and each nursing group knowledge in this area. Dorji [17] studied the attitudes of health professionals toward persons with disability in Bhutan. Research result illustrated that physicians held significantly more positive attitudes than nurses on total of Scale of Attitudes toward Disabled persons (SADP). And the optimism-human rights subscale (p<.01). In this study Bhutanese physicians and nurses appear to hold less positive attitudes toward persons with disabilities than their counterparts from western countries.
The attitudes of nursing students toward children with disabilities were studied by Cervasio [18]. The result of this study suggested that there is a significant difference in means of the Attitudes towards Disabled Persons Scale (ATDP-B) measurements between the groups of the study which indicates the graduating nurses who received disability education performed significantly better on an assessment of attitudes toward children disabilities than those who did not receive the education. A study conduct by Matziou [19] on paediatric nurses and nursing students toward disabled children attitudes .The overall nursing attitudes appeared to be poor, however the graduate nursing had significantly higher. In the study the female nurses hold significantly higher positive attitudes but the age didn't have any significant effect than male. Another study explored the Knowledge and attitudes of nurse in Jordan dealing with patients having HIV/AID, particularly in regards to their information and education. The results shows all negative attitudes toward delivering nursing care ( 96.22%) ranked fear of getting AIDs from their nursing practice Hassan [20].
A study conducted to explore the attitudes of health care professionals (489) teachers and their students (511) towards LOJ Nur Heal Car 28 people with disabilities in Hong Kong. The attitudes of four groups of professionals and students were assessed by using The Attitude toward disabled persons scale (ATDPS). Comparisons were made among different groups of students and professionals. Results indicated that the overall Mean Attitude toward disabled person scale (ATDPS) of the respondents was comparatively lower than that of their counterparts in other countries. The professionals had had significantly higher score than that of the students. Among the four disciplines, nurses held the least favorable attitudes towards people with disabilities. In addition, their attitudes were less positive than those of student nurses. On the other hand, the social worker students had less favorable attitudes than the professional social workers, as well as other types of health care students. The analysis of the data also revealed that the mean (ATDPS) scale scores for both the occupational therapists and occupational therapy students were above the overall average. Unlike the physiotherapists, the Mean (ATDPS) score of the physiotherapist students was below the overall average. In addition, age, year of study, educational level, knowledge and contact with people with disabilities were significant factors in the attitudes held by the students and professionals' respondents. The quality of the contact was found to be a dominant factor in affecting the scores on attitude.
Thus, recommendations were made to modify the current training curriculum and enhance the quality of services to develop more favorable attitudes towards people with disabilities' Boye MJ [21]. Attitudes of undergraduate students enrolled in six different health related courses at Monash University towards patients with Intellectual disability, substance abuse and acute mental illness. The results indicated statistically significant differences were found between the courses (p=0.05), year of the course (p=0.09), and gender (p=0.04) for the medical condition of intellectual disability. There was no statistically significant difference between the courses, year of the course, gender, and age group for substance abuse or acute mental illness conditions. The findings suggest that students in undergraduate health-related courses, as a group, have strong regard for patients with intellectual disability and some regard for patients with acute mental illness, but not for patients presenting with substance abuse problems. A study by Brinn F [22] to measure the emotional reactions and expectation of 64 nurses in a general hospital to vignettes describing patients with unstable diabetes and a co-morbid psychiatric diagnosis. Finding suggested that the nurses in the study sample were fearful of people with mental health problem. They were wary of possible unpredictable behavior. Qualified staff generally felt better equipped to cope with such patients depending on their psychiatric experience. In conclusion, general adult nurses who have had more exposure to patients with mental health problems during their initial training are more likely to feel adequately prepared for managing people with mental health problems.
A study aimed at examining occupational therapy students' attitudes towards individuals with disabilities from international-cross cultural perspective and to investigate the possible impact of professional education on students.' Significant differences were found between occupational therapy students from Australia, Taiwan, the United States, and the United Kingdom on the following: IDP variables: overall attitudes towards individuals with disabilities, discomfort 'sympathy' uncertainty 'coping' fear, and vulnerability'. Significant differences between first year students as a total group were found on their overall attitudes towards individuals with disabilities, discomfort, and uncertainty. In other words ,the attitudes towards individuals with disabilities among first year and final year occupational therapy students varies between countries and the students' year level also impacts on their attitudes towards individuals with a disability Brown T [23].
Park [24] compared the attitudes toward and contact with people with disabilities among health care professionals, lay persons and disabled persons. Attitude and contacts were assessed using (ATDPS) and the contact with Disabled Persons. Overall attitude score of the subjects in group of health care professionals, lay persons, and disabled persons were lower than those of individuals in the corresponding groups in other countries (F=3.232), (p=.0.31).Health care professionals and lay persons had more negative attitudes towards disabled persons than those of disabled persons. Scores of the contact with Disabled were also lower in all three groups, as compared to those of corresponding group from other countries. Disabled persons had significantly more contact experience with disabled persons than individuals in other two groups. In conclusion health care professionals as well as lay persons and disabled persons have negative attitudes toward people with disabilities. It is needed that the modification of educational curriculums in nursing school for promoting positive attitudes toward people with disabilities. A study project by Roa [25] aimed to assess stigmatized attitudes among health professionals directed towards patients with mental health problem.
The attitude to mental illness questionnaire was used to assess participants' attitudes towards fictitious patients from a secure forensic hospital and patients with schizophrenia and substance use disorders. Participants were health professionals from acute and mental health settings. In total 108 completed questionnaires were received. Participants had highly stigmatized attitudes towards patients from a forensic hospital and those with active substance used disorders .Attitudes less stigmatized to people with substance use disorders who were recovering in remission. This suggested that health professionals have stigmatized attitudes towards an illness such as schizophrenia and this is worse towards patients from a secure hospital. The manner in which patients with substance use disorder are presented can have a significant effect on stigmatized attitudes by health professionals. A survey of attitudes to mental illness by Schafer [26] performed by using the Community Attitudes to Mental illness Questionnaire was completed and ethnicity proved to be an important factor in accounting for variation in attitudes to mental illness. The Black and Black British group displayed less positive attitudes across all nursing branches when compared to the white group. The differences raised questions about how best when compared to the white group. The differences raised questions about how best nurse training can prepare nurse to practice in culturally sensitive ways that acknowledge the beliefs of patients whilst avoiding stereotyping and discrimination. Personal contact with someone with mental illness was also found to be significant factor and the important of user involvement in training was discussed. The paper concluded with some recommendations for nursing training that included greater use of teaching strategies that challenged beliefs and assumptions and promote a commitment to multicultural mental health practice  determined the attitudes of Jordanian people toward physical disabilities. The study result scored that females were better in both behaviour and attitudes toward disabled.
There were significant differences in attitudes according to age, with the best attitudes depicted in aged group (18)(19)(20)(21)(22)(23)(24)(25). There were significant difference in behaviour and attitudes according to level of education. The best results were amongst PHD holders. There was positive behaviour and positive attitude towards the disabled but people with positive attitude didn't necessarily show positive behaviour towards the disabled. In summary many studies were focused on the field of nursing attitudes toward patients with Intellectual disability. However, rare studies were conducted on other disabilities categories, so we still need to study the attitudes of nursing toward other categories of individuals with disabilities (i.e. hearing impairment and deaf, visual impairment, blind, autistic patients and, Learning disability etc.). But there is no study on the attitudes of nursing toward caring the patients with these disabilities.

The Aim
The aim of this study is setting out to investigate the attitudes and emotional reaction of the nurses in Jordan hospitals who deliver nursing caring for patients with special needs. To achieve the aim of this study the following detailed aims were thrown: To examine the attitudes of the Jordanian nurses towards patients with special needs. To identify independent determinants of attitudes toward patient with special needs Research questions: To perform the aims of the study the following two questions were set a) What attitudes and emotions towards patient with disability the nurse reported?
b) To what extent the nurse accepted the individual with disability as a client?

Research Hypothesis
Nursing staff would report positive attitudes and positive emotional response towards patients with disabilities. Nurses would report s negative Attitudes and emotional response toward patients with disabilities.

Methodology and Procedure
To achieve the study aims, the research will construct a special tool to measure the attitudes and emotion responses of the nurse toward caring the individual with disabilities in Jordan Public Hospital. The tool was translated to Arabic language by English Language expert then translates into English language again to see if it is similar with the original copy. Then the tool was validated and judged by a group of experts in education and psychology evaluation and management.

Research Sample
The sample consists of (91) nurses of both sexes and different level of education, experience, age and other demographic variables. The sample were selected randomly from 3 public hospitals in Jordan Amman (40 nurses), Mafraq (20 nurses), Zarqa (30 nurses)

Data collection
A special tool composed of three parts: demographic information, attitude scale, emotion scale was used to collect the data.

Data Analysis
Statistical Package of social science (Spss) were used I,e Correlation(bivariate) and descriptive( frequency).

Result
Analyzing the participant responses shows the (57%) N=52 were male and (42.9%) '(N=39) were female. The experience of the participants between (1-40 years), furthermore (50.5%) N=46 have an experience of 1to 4 years; (22%), N=20 have 5-9 years. (19.8%) participants were of 10-18 years experience. 7.7% n=7 have experience between 20-40 years. In addition, 64 were staff nurses and 27 were assistant nurses. Concerning care delivered to individuals the results shows that (58.2%) N= 53 have the chance to deliver nursing care to one or more individuals with disability meanly to individuals with physical disability (20.9%) N=19. Other disability were very rare i.e. 1% ASD,V,3%,2%, 1% ASD. As the participant were questioned if they have disability (64.8 %) N=59, no they haven't. On the other hand (48.4%) N=32 said they have contacted individuals with disability regardless to the type of disability. As the participants were asked if they have not contacted individuals with (43%) N=. When the researcher investigated the duration of contact, it appears that 15(16.5) of the participants contact an individual (s) with disability onetime per month while (11%) N=10 contacted them several times per week.
Finally 57 (62.6%) participants have a relative with disability. However (30.8%) of the participants have not relatives with disability. As the data related to attitudes and emotions were analyzed it is revealed that they weren't significant correlation between the demographic variables ( Age, sex, experience, title ) and the attitudes and emotions of the nurses toward the disabled patients (p>0.05) collectively, but there was a significant correlation between the attitudes and emotion (p<0.05).

Recommendation
Further study is needed to investigate the correlation between the demographic variables and the attitudes and emotion of the nursing staff who works with the individuals with disabilities. In addition the researcher recommends to apply this study on the nurses who work with a lot of individuals with disabilities such those who works in resource room integrated schools and the special education centers where there is a residency in them.