In brief
In this Egyptian study of 184 baccalaureate nursing students, most showed improved (less stigmatizing) attitudes toward patients with mental illness on the CAMI scale after completing psychiatric nursing and mental health coursework and clinical experience. About two-thirds improved on authoritarianism and social...
What this article is about
Quick Answer
In this Egyptian study of 184 baccalaureate nursing students, most showed improved (less stigmatizing) attitudes toward patients with mental illness on the CAMI scale after completing psychiatric nursing and mental health coursework and clinical experience. About two-thirds improved on authoritarianism and social restrictiveness, and more than half improved on benevolence and community mental health ideology.
Student takeaways
Key Takeaways
- The study evaluated attitude change in 184 baccalaureate nursing students at Alexandria University's Faculty of Nursing during their eighth semester of the 2012-2013 academic year.
- Attitudes were measured using the Community Attitudes toward the Mentally Ill (CAMI) Scale before and after a psychiatric nursing and mental health educational experience.
- About two-thirds of students showed improved (less stigmatizing) attitudes on the authoritarianism subscale after completing the psychiatric nursing experience.
- About two-thirds of students also showed improved attitudes on the social restrictiveness subscale after the educational experience.
- More than half of students showed improved attitudes on both the benevolence and community mental health ideology subscales, and the authors concluded the educational experience brought significant overall improvement in students' attitudes toward patients with mental illness.
Student summary
Why This Research Matters
Nursing students, like the general public, can carry negative or fearful attitudes toward people with mental illness before they ever set foot in a psychiatric unit. This 2014 study from the Faculty of Nursing at Alexandria University in Egypt asked a straightforward question: does completing psychiatric nursing and mental health coursework and clinical experience actually change those attitudes for the better?
The researchers, Laila Ossman and Marwa Abd El-Gawad, studied 184 baccalaureate nursing students who were in their eighth (final) semester during the 2012-2013 academic year. Every student in the group had just finished their psychiatric nursing and mental health educational experience, which combined classroom theory with supervised clinical practice on psychiatric units. To measure attitudes, the team used two tools. The first was a questionnaire collecting each student's socio-demographic background and any prior personal experience with mental illness, such as knowing a family member or friend affected by it. The second, and more central, tool was the Community Attitudes toward the Mentally Ill (CAMI) Scale, a well-established instrument used internationally to measure attitudes along four dimensions: authoritarianism (the belief that people with mental illness need firm, controlling management), social restrictiveness (the belief that people with mental illness are dangerous and should be kept apart from society), benevolence (a sympathetic, caring view of people with mental illness), and community mental health ideology (support for treating and integrating people with mental illness within the community rather than isolating them in institutions).
Students completed the CAMI scale before and after their psychiatric nursing experience, allowing the researchers to compare attitudes before and after the educational exposure. The results were encouraging. About two-thirds of students showed improved (less stigmatizing) attitudes on the authoritarianism and social restrictiveness subscales after their coursework and clinical rotation. More than half of the students also showed improvement on the benevolence and community mental health ideology subscales. In other words, the majority of students moved toward viewing people with mental illness as less dangerous, less in need of coercive control, and more deserving of compassionate, community-based care after their educational experience, compared with how they felt beforehand.
The authors concluded that structured psychiatric nursing and mental health education, when it combines classroom learning with real clinical contact, can produce meaningful, measurable improvements in nursing students' attitudes toward people with mental illness. Because attitudes shape how nurses interact with patients, this matters well beyond the classroom: a nurse who sees a person with schizophrenia or depression as dangerous or beyond help is less likely to build trust, encourage treatment adherence, or advocate for that patient's dignity. Based on their findings, the researchers recommended that nursing faculties across Egypt intentionally factor students' baseline attitudes into how they design psychiatric nursing curricula, rather than assuming exposure alone will do the job. They also called for further research into what other factors, beyond formal coursework, might shape or reinforce these attitude changes, such as the quality of clinical mentorship, prior personal exposure to mental illness, or cultural attitudes students bring from their communities.
For a nursing student reading this study, the practical takeaway is that your attitudes toward psychiatric patients are not fixed. They are shaped by education and clinical exposure, and this study suggests that a well-structured psychiatric rotation genuinely can shift how you think about people living with mental illness. It is also a useful reminder to notice your own reactions during a psychiatric placement: are you defaulting to fear or control, or moving toward empathy and support for community-based care? The study only measured students at one Egyptian faculty at one point in time, so its numbers should not be generalized automatically to every nursing program, but the underlying idea, that structured psychiatric education can reduce stigma among future nurses, is echoed across similar research in other countries.
Source abstract
Study Overview
The general public and even many health professionals, including nurses, tend to holda stereotyped image of those with mental illness. It is well documented that undergraduatenursing students can hold negative attitudes toward people with mental illness that can bepositively impacted and manipulated by proper psychiatric nursing education. Objective: Thisstudy aimed to assess the change in baccalaureate nursing students' attitudes toward patientswith mental illness before and after psychiatric nursing and mental health educationalexperience. Setting: The study was conducted at the Faculty of Nursing, AlexandriaUniversity. Subjects: Subjects comprised 184 students who where registered in the eighthsemester of the academic year 2012-2013. Tools: Tools used to collect data for this studywere a Student's Socio-demographic Characteristics and Previous Experience with MentalIllness Questionnaire and Community Attitudes toward the Mentally Ill (CAMI) Scale.Results: It was found that around two thirds of students showed improvement in theirattitudes related to authoritarianism and social restrictiveness, while more than half showedimprovement in benevolence and community mental health ideology after completingpsychiatric nursing educational experience. Conclusion: Psychiatric nursing and mentalhealth educational experience can bring significant improvements in students' attitudestoward patients with mental illness. Recommendations: Considering students' attitudestoward patients with mental illness while designing psychiatric nursing curricula at allEgyptian faculties of nursing is essential. Future researches are also required to study whatother factors probably contributed to the change in these attitudes.
Evidence appraisal
Main Findings
- The study evaluated attitude change in 184 baccalaureate nursing students at Alexandria University's Faculty of Nursing during their eighth semester of the 2012-2013 academic year.
- Attitudes were measured using the Community Attitudes toward the Mentally Ill (CAMI) Scale before and after a psychiatric nursing and mental health educational experience.
- About two-thirds of students showed improved (less stigmatizing) attitudes on the authoritarianism subscale after completing the psychiatric nursing experience.
- About two-thirds of students also showed improved attitudes on the social restrictiveness subscale after the educational experience.
- More than half of students showed improved attitudes on both the benevolence and community mental health ideology subscales, and the authors concluded the educational experience brought significant overall improvement in students' attitudes toward patients with mental illness.
Practice transfer
Clinical Relevance
- Nurse educators can expect that a well-structured psychiatric nursing course combined with clinical placement is likely to shift many students toward less stigmatizing, more compassionate views of patients with mental illness.
- Because authoritarianism and social restrictiveness improved most, clinical instructors should watch for and gently challenge assumptions that psychiatric patients require coercive control or must be kept isolated from the community.
- Improvements in community mental health ideology suggest that clinical rotations emphasizing community-based and recovery-oriented psychiatric care may reinforce nursing students' support for integrating people with mental illness into everyday community life.
- Since more than a third of students did not show improvement on some subscales, faculty should not assume a single course guarantees attitude change for every student and may need supplementary strategies (e.g., contact-based learning, reflective debriefing) for those whose views remain unchanged.
- Given the study's Egyptian, single-institution context, nurse leaders elsewhere should treat these findings as supportive evidence for anti-stigma education rather than a guarantee that identical results will occur in different cultural or curricular settings.
Faculty notes
Educational Relevance
This 2014 article from the Alexandria Scientific Nursing Journal reports a one-group pre-test/post-test evaluation of a psychiatric nursing and mental health educational experience for baccalaureate nursing students at the Faculty of Nursing, Alexandria University, Egypt. The sample comprised 184 students in the eighth (final) semester of the 2012-2013 academic year. Data were collected using two instruments: a Student's Socio-demographic Characteristics and Previous Experience with Mental Illness Questionnaire, and the Community Attitudes toward the Mentally Ill (CAMI) Scale, administered before and after the students' psychiatric nursing coursework and supervised clinical experience.
The CAMI scale, developed by Taylor and Dear, is a widely used 40-item instrument assessing four attitudinal dimensions: authoritarianism, social restrictiveness, benevolence, and community mental health ideology. The first two subscales capture controlling and stigmatizing views, while the latter two capture sympathetic and community-integration-oriented views. Reported findings indicate that approximately two-thirds of students showed improved (less stigmatizing) scores on the authoritarianism and social restrictiveness subscales following the educational experience, and more than half improved on the benevolence and community mental health ideology subscales. The authors concluded that psychiatric nursing and mental health education produces significant improvements in nursing students' attitudes toward patients with mental illness, and recommended that Egyptian nursing faculties deliberately account for students' baseline attitudes when designing psychiatric nursing curricula, alongside further research into other contributing factors.
For classroom discussion, this article works well as a case study in curriculum evaluation using a validated attitude-measurement instrument. Instructors can use it to illustrate the logic of a pre/post design, the value of using a standardized, multi-dimensional scale like CAMI rather than a single global attitude question, and the distinction between statistically described "proportion improved" reporting versus effect-size or significance-testing approaches. Because the abstract reports the proportion of students who improved on each subscale rather than mean score changes, significance levels, or effect sizes, it offers a useful prompt for students to consider what additional statistical detail they would want before drawing firm conclusions.
The study's design has clear limitations worth foregrounding with students: it lacks a control or comparison group, so improvement cannot be definitively attributed to the educational intervention rather than to maturation, other coursework, or simple retesting effects; it draws from a single institution and country, limiting generalizability across health systems and cultures; and the abstract available for this review does not specify inferential statistics, response rate, or the interval between pre- and post-tests. These are productive prompts for a research-appraisal seminar: what would a stronger design look like, and what threats to internal validity does a one-group pre/post design leave unaddressed?
Clinically and pedagogically, the study reinforces a widely replicated finding in psychiatric nursing education literature: structured educational exposure, particularly when it combines classroom content with supervised clinical contact, is associated with reduced stigma and more favorable attitudes toward people with mental illness among nursing students. Faculty can use this article to prompt discussion about how program-level curriculum design, not just individual instructor effort, shapes graduates' readiness to provide non-stigmatizing, recovery-oriented psychiatric care, and to encourage students to critically evaluate whether attitude change reported in a study like this is likely to be durable once students enter independent practice.
Critical appraisal
Limitations
- The design used a single group measured before and after the educational experience, with no control or comparison group, so improvements cannot be definitively attributed to the intervention rather than to time, maturation, or other concurrent coursework.
- The sample was drawn from one faculty of nursing in Alexandria, Egypt, at one point in time, limiting how far the findings can be generalized to other countries, curricula, or student populations.
- The abstract reports the proportion of students who improved on each CAMI subscale but does not provide mean score changes, statistical significance testing, or effect sizes, making it hard to judge the strength or reliability of the reported improvement.
Classroom use
Discussion Questions
- Why might a nursing program choose the CAMI scale, with its four distinct subscales, over a single overall attitude question when evaluating a psychiatric nursing course?
- What are the main threats to internal validity in a one-group pre-test/post-test design like the one used in this study, and how could a future study address them?
- Why do you think authoritarianism and social restrictiveness improved for a larger proportion of students than benevolence and community mental health ideology did?
- How might supervised clinical contact with real psychiatric patients contribute to attitude change beyond what classroom theory alone could achieve?
- What role could students' prior personal experience with mental illness (collected but not detailed in the abstract) play in how much their attitudes shifted?
- If more than a third of students did not show improved attitudes on a given subscale, what additional educational strategies might help reach that group?
- How could social desirability bias affect self-reported attitude scores collected immediately after a psychiatric nursing course, and how might researchers reduce this risk?
- In what ways could persistent authoritarian or socially restrictive attitudes among nursing students affect the quality of care patients with mental illness receive?
- The authors recommend factoring students' attitudes into curriculum design across Egyptian nursing faculties; what would that look like in practice?
- How might findings from a single Egyptian faculty of nursing translate, or fail to translate, to nursing programs in other cultural or healthcare contexts, such as Canada?
Knowledge check
Quiz
1. Where was this study conducted?
- Faculty of Nursing, Alexandria University
- Faculty of Nursing, Cairo University
- A community hospital in Toronto
- A psychiatric hospital in Beirut
Rationale: The abstract states: 'Setting: The study was conducted at the Faculty of Nursing, Alexandria University.'
2. How many nursing students participated in this study?
- 84
- 184
- 284
- 1,840
Rationale: The abstract states: 'Subjects comprised 184 students who were registered in the eighth semester of the academic year 2012-2013.'
3. Which scale was used to measure students' attitudes toward patients with mental illness?
- Community Attitudes toward the Mentally Ill (CAMI) Scale
- Beck Depression Inventory
- Attitudes Toward Nursing Scale
- Stigma-9 Questionnaire
Rationale: The abstract states the tools used included 'Community Attitudes toward the Mentally Ill (CAMI) Scale.'
4. According to the abstract, on which two subscales did about two-thirds of students show improvement?
- Authoritarianism and social restrictiveness
- Benevolence and community mental health ideology
- Anxiety and depression
- Empathy and burnout
Rationale: The abstract states: 'around two thirds of students showed improvement in their attitudes related to authoritarianism and social restrictiveness.'
5. According to the abstract, more than half of students showed improvement in which two areas?
- Benevolence and community mental health ideology
- Authoritarianism and social restrictiveness
- Clinical skills and communication
- Test anxiety and academic confidence
Rationale: The abstract states: 'more than half showed improvement in benevolence and community mental health ideology after completing psychiatric nursing educational experience.'
6. What was the main conclusion of this study?
- Psychiatric nursing and mental health educational experience can bring significant improvements in students' attitudes toward patients with mental illness
- Nursing students' attitudes toward mental illness cannot be changed through education
- Clinical exposure worsens nursing students' attitudes toward psychiatric patients
- Attitudes toward mental illness are unrelated to nursing curricula
Rationale: The abstract states: 'Conclusion: Psychiatric nursing and mental health educational experience can bring significant improvements in students' attitudes toward patients with mental illness.'
7. What did the study's authors recommend for Egyptian faculties of nursing?
- Considering students' attitudes toward patients with mental illness while designing psychiatric nursing curricula
- Removing psychiatric nursing content from the curriculum
- Replacing clinical placements with online-only coursework
- Limiting psychiatric rotations to graduate students only
Rationale: The abstract states: 'Considering students' attitudes toward patients with mental illness while designing psychiatric nursing curricula at all Egyptian faculties of nursing is essential.'
8. Which academic year and semester were the study subjects enrolled in?
- Eighth semester, academic year 2012-2013
- First semester, academic year 2010-2011
- Fourth semester, academic year 2015-2016
- Sixth semester, academic year 2012-2013
Rationale: The abstract states subjects 'were registered in the eighth semester of the academic year 2012-2013.'
9. What key limitation applies to this study's design, based on the information available in the abstract?
- It used a single group measured before and after the intervention, without a comparison group
- It randomly assigned students to a control and treatment group
- It followed students for ten years after graduation
- It included students from twenty different countries
Rationale: The abstract describes assessing 'the change in baccalaureate nursing students' attitudes... before and after psychiatric nursing and mental health educational experience' in one cohort, consistent with a one-group pre/post design and no mention of a comparison group.
10. What did the abstract recommend for future research?
- Studying what other factors probably contributed to the change in students' attitudes
- Discontinuing the use of the CAMI scale in nursing research
- Focusing exclusively on graduate nursing students
- Eliminating socio-demographic data collection from future studies
Rationale: The abstract states: 'Future researches are also required to study what other factors probably contributed to the change in these attitudes.'
Study cards
Flashcards
What was the main aim of this study?
To assess the change in baccalaureate nursing students' attitudes toward patients with mental illness before and after a psychiatric nursing and mental health educational experience.
Where was the study conducted?
At the Faculty of Nursing, Alexandria University, Egypt.
How many students participated?
184 students registered in the eighth semester of the 2012-2013 academic year.
What two data collection tools were used?
A Student's Socio-demographic Characteristics and Previous Experience with Mental Illness Questionnaire, and the Community Attitudes toward the Mentally Ill (CAMI) Scale.
What does the CAMI scale measure?
Attitudes toward people with mental illness across four dimensions: authoritarianism, benevolence, social restrictiveness, and community mental health ideology.
What is 'authoritarianism' in the CAMI framework?
A view of people with mental illness as requiring coercive, controlling management.
What is 'social restrictiveness' in the CAMI framework?
The belief that people with mental illness are a threat to society and should be avoided or kept apart from the community.
What is 'benevolence' in the CAMI framework?
A sympathetic, paternalistic, and caring view toward people with mental illness.
What is 'community mental health ideology' in the CAMI framework?
Support for treating people with mental illness within and integrating them into the community rather than isolating them in institutions.
What proportion of students improved on the authoritarianism and social restrictiveness subscales?
Around two-thirds of students showed improvement on these two subscales after the educational experience.
What proportion of students improved on the benevolence and community mental health ideology subscales?
More than half of students showed improvement on these two subscales.
What was the study's overall conclusion?
Psychiatric nursing and mental health educational experience can bring significant improvements in students' attitudes toward patients with mental illness.
What did the authors recommend for nursing curricula?
That Egyptian faculties of nursing consider students' attitudes toward patients with mental illness when designing psychiatric nursing curricula.
What future research did the authors call for?
Research into what other factors probably contributed to the observed change in students' attitudes.
Who developed the CAMI scale, based on supplementary background research?
The CAMI scale was originally developed by Taylor and Dear as a widely used instrument for measuring community attitudes toward mental illness.
What kind of study design does this appear to be?
A one-group pre-test/post-test evaluation of an educational (psychiatric nursing) experience, based on the abstract's description of measuring attitudes before and after the intervention.
Why is a lack of a control group a limitation here?
Without a comparison group, improvement in attitudes cannot be definitively attributed to the psychiatric nursing course rather than to other factors like time, maturation, or concurrent coursework.
In what journal and year was this study published?
The Alexandria Scientific Nursing Journal, in 2014.
Why might attitude change matter for clinical nursing practice?
Nurses' attitudes toward patients with mental illness can affect trust, communication, treatment adherence, and advocacy for patient dignity in psychiatric and general care settings.
What socio-demographic data did the study collect that is not detailed in the abstract's results?
Students' socio-demographic characteristics and prior personal experience with mental illness, collected via a dedicated questionnaire alongside the CAMI scale.
Search-ready answers
Frequently asked questions
What is this study about?
It examines whether completing psychiatric nursing and mental health coursework and clinical experience changes baccalaureate nursing students' attitudes toward patients with mental illness, using the CAMI scale before and after the experience.
Who were the participants in this study?
184 baccalaureate nursing students in their eighth semester at the Faculty of Nursing, Alexandria University, during the 2012-2013 academic year.
What is the CAMI scale used for?
The Community Attitudes toward the Mentally Ill (CAMI) Scale measures attitudes toward people with mental illness across four dimensions: authoritarianism, benevolence, social restrictiveness, and community mental health ideology.
Did nursing students' attitudes improve after psychiatric nursing education?
According to the abstract, yes for most students: about two-thirds improved on authoritarianism and social restrictiveness, and more than half improved on benevolence and community mental health ideology.
Does this study prove that psychiatric nursing courses cause attitude change?
Not definitively. The study appears to use a single-group before-and-after design without a comparison group, so it cannot rule out other explanations such as maturation or concurrent coursework.
What did the researchers recommend based on their findings?
That nursing faculties across Egypt consider students' attitudes toward patients with mental illness when designing psychiatric nursing curricula, and that future research explore what other factors contribute to attitude change.
Why does nursing student attitude toward mental illness matter for patient care?
Attitudes shape how nurses interact with patients; more accepting, less stigmatizing attitudes are associated with better communication, trust, and support for community-based, recovery-oriented care.
Can these findings be applied to nursing programs outside Egypt?
With caution. The study was conducted at a single Egyptian faculty of nursing, so cultural, curricular, and healthcare-system differences elsewhere may affect how well the findings generalize.
What are the main limitations of this study?
Key limitations include a lack of a control group, a single-institution sample, limited statistical detail in the available abstract, potential social desirability bias in self-reported attitudes, and incomplete methodological detail such as the exact testing interval.
Where was this study published?
It was published in the Alexandria Scientific Nursing Journal in 2014, and it is available as an open-access article.