ht.
.I. NWS. Stud. Vol. 14, pp. 63.68, Pergamon
Press.
1977. Printed in Great Britain.
Integration of mental health concepts into general nursing education in Nigeria -A survey of nurses opinions ’
ROSALINE A. OLADE Department of Nursing, University of Ibadan, Ibadan. Nigeria
Introdaction Prior to 1965, the teaching of mental health nursing was not considered as a compulsory part of the basic nursing curriculum in diploma schools of nursing in Nigeria. The adoption of this compulsory requirement by the Nursing Council of Nigeria in 1965 was based on the recommendation of the Special Committee on New Standards of NurseTraining in Nigeria, Nursing Council for Nigeria (1965). It specified that “experience in the psychiatric field should be obtained in a ward unit of 12 beds, or alternatively approved special centre or outpatient department” (Nursing Council for Nigeria, 1965).
in an
For this purpose, 8 weeks are allocated for both theory and clinical experience in psychiatric nursing. Very few hospitals in this country can meet the clinical requirement of a 12-bed psychiatric unit. Moreover, approved special psychiatric centres or mental hospitals are very few and far apart. Because of this apparent lack of adequate clinical facilities, many diploma schools of nursing in Nigeria are forced to send their students for practical experience in the very few mental hospitals that possess clinical and some teaching facilities, such as Aro Mental Hospital near Abeokuta. This experience may take the form of either periodic visits or in-residence training for varying periods. Many nursing schools that cannot avail themselves of such facilities offer either no psychiatric training or teach only theoretical principles to the students. It is an admitted fact that mental care needs considerable improvement in this country. The impact of the so-called Western civilization as evidenced by rapid industrialization, increased rural-urban migrations, detribalixation and disruption of extended family systems, has increased mental stresses within the society. To ameliorate the situation the Federal Government has planned to construct more psychiatric units or hospitals, at least one in each state. The achievement of such a desirable goal will make mental health services more accessible to more people in all parts of the country. Considering the acute shortage of qualified psychiatrists in the country, nurses will 63
64
ROSALINE A. OLALIE
definitely play a very important role in the dispensation of mental health care in the proposed psychiatric institutions, as well as in the general community. Since we only have about 450 specially-trained psychiatric nurses (Registered Mental Nurses) in the country, Federal Office of Statistics (1974), it is obvious that general nurses will have to be employed to provide mental health care. The efficiency of this cadre of nurses in performing these necessary services strongly depends on the nature and extent of their psychiatric training. After more than a decade of introducing psychiatric nursing into general nursing curriculum in Nigeria, this paper investigates the opinion of nurses about their preparation for the role of providing efficient mental health care. Methodology This survey involved 73 registered general nurses who are presently undergoing postbasic nursing training at the Department of Nursing, University of Ibadan. They all possess at least a year of post-qualification experience, and obtained their nursing diplomas from various categories of hospitals in the country. Out of the group, 19 trained in missionary hospitals, 23 in general hospitals, and 31 in teaching hospitals. Fifty-one students or about 70% of the group entered diploma nursing schools in 1966 or thereafter. A questionnaire designed by the author was distributed to the students, requesting information about their category of training schools, the number of weeks used in learning psychiatric nursing (theory and/or practical). Also the questionnaire was set to inquire about the adequacy of the psychiatric experience and their general comments on psychiatric integration. Since the survey was designed to evaluate psychiatric integration into nursing curriculum in Nigeria, nurses who had their basic training overseas were excluded from the analysis of results.
Results of this survey are summarised in Tables 1 and 2. These are arranged according Table 1. The amount of psychiatric nursing experience which respondents had during basic training
Number of weeks of theoretical and clinical experience in psychiatry Training school o-2
WI
2-4
(%I
6-8
4-6
8-10
(N-l
(%)
(N)
(%I
09
(%)
(N)
1
10 - 12
w
(%)
4.4
3
13
(%I
General hospitals N=23
6
26
4
17.5
3
13
6
26
Missionary hospitals N=19
8
42
2
10.5
5
26
4
21
Teaching hospitals N=31
7
22.5
7
22.5
8
26
5
16
1
3.3
3
10
22
30
15
19
19
25
12
16
2
2.1
5
6.8
All hospitals N=l3
65
INTEGRATIONOFMENlA.LHEALTHCONCEPTSINNIGE~
to the category of hospital training schools, and length of theoretical and practical experience in psychiatric nursing. As evident in Table 1, the number of weeks of training ranges from 0 to 12 weeks. A histogram plot (not shown here) of the values shows a normal distribution with a median value of about 4 weeks. Considering the study population in detail, only 16% had up to 8 weeks psychiatric experience, which is the minimum period recommended by the Nursing Council. Slightly more than 30% were exposed to a maximum of 2 weeks or no psychiatric training at all. About 19% of the group had 2-4 weeks experience, while 25% had 4-6 weeks of psychiatric nursing, both theory and practical. It is however interesting to note that 9.5% of the study population claim to have obtained more than 8 weeks experience. This is probably attributable to the fact that other courses in nursing are commonly sandwiched or alternated with that of psychiatry. Consequently an overestimation in the length of psychiatric training, cannot be ruled out. Moreover, it is apparent in Table 1 that among the 30% who had less than 2 weeks training, almost half were trained in missionary hospitals. This may have something to do with religious attitudes to psychiatry. In addition the missionary nursing schools are most likely to be located in relatively more remote areas of the country, and because of their limited financial strength, they may not be able to avail themselves of the necessary expenses of bringing students to urban psychiatric centres. A summary of the opinions of the nurses with respect to the adequacy of their preparation for psychiatric nursing, is presented in Table 2. As expected, 100% of those who had less than 2 weeks psychiatric preparation felt it was inadequate, while one-third of those who had 6-8 weeks training considered it as just adequate. It is noteworthy that all of those who claimed a training of more than 8 weeks felt it was inadequate, which supports the earlier supposition that not all this period was used for psychiatric Table 2. Nurses opinions about the psychiatric nursing content of their basic training
Adequacy of preparation No. of weeks Very 8
Just
(%I
8
Not (%)
WI
(%I
o-2
0
0
0
0
22
100
2-4
0
0
1
6.1
14
93.3
4-6
0
0
1
5.2
18
94.8
6-8
0
0
4
33.3
8
66.1
8 - 10
0
0
0
0
2
100
0
0
3
60
2
40
10-12
experience alone. On the whole, 85% of the study population felt they were not adequately propared while 15% considered their preparation as just adequate. Surprisingly, not a single nurse felt very adequately prepared at the basic level to provide psychiatric nursing care.
66
ROSALINE A. OLALIE
Discussion Results presented above demonstrate that the majority of nurses examined in this survey consider their psychiatric experience during basic nursing training as inadequate. They however realize the usefulness and necessity of psychiatric nursing integration into basic nursing curiculum. This is evident from the comments made by these nurses in the free-response section of the questionnaire. They feel that it is very necessary to receive lectures in psychology which will enhance their understanding of psychiatric disorders. A knowledge of mental health concepts and psychology is not only necessary in the nursing of psychiatric patients but extremely useful for nursing man in his totality, in all aspects of nursing intervention. In fact ‘the socio-psychological components of nursing care have long been recognised as important in the care of patients, Pesznecker and Hewitt (1963). In our society, there is still a great deal of stigma attached to mental illness, even among nurses, especially general nurses who have little or no orientation to psychiatric nursing. The existence of such a stigma within the nursing profession can mar the efficiency of the nurses in the delivery of mental health care. Rather than becoming professional nurses who can interact with and take care of their patients, they may virtually turn out to be just ‘dispensers’ of medicines, which is not the only way of treating psychiatric disturbances. Most of the nurses examined in this survey recommend a better integration of mental health concepts and clinical training into the basic nursing curriculum. This will go a long way in dispelling the cultural belief among nurses about the ethiology of psychiatric disorders and thereby laying the foundation for the introduction of modern techniques of psychiatric nursing and treatments. Apart from complying with the minimum requirement of 8 weeks of psychiatric nursing education it is also essential that the theoretical and practical training should be given in a meaningful and most useful manner. Opinions obtained in this survey show bitter criticisms of the method of paying just observational visits to mental hospitals as a major component of the student’s psychiatric clinical experience. The fact is that, for most of these scheduled visits (usually once a week or fortnight), the patients are usually prepared or made aware of the oncoming visit. Thus the experience obtained by the students is not typical and often lacks direct student participation in the everyday care of the patients. Moreover, a lack of adequate hostel accommodation in the mental hospitals may not permit longer or extended visits by the students, when this is desirable. A closer look at the theoretical aspects of psychiatric orientation as given in most basic schools of nursing in Nigeria, reveals that most of the lectures are given by psychiatrists who are usually invited as guest lecturers. In most instances no laid-down syllabus is provided, and the nurses are taught more or less as medical students. While this pattern of teaching may be acceptable, the most important aspect to be stressed in psychiatric teaching of nurses is the ‘art’ of nursing the mental patients. A WHO Expert Committee noted that: “The modem nurse requires, first of all, an understanding of the mental, physical and social needs of all types of people both sick and well . . . . The teaching of these attitudes and skills is primarily the responsibility of nursing educators whether they be specially qualified nurse tutors or other senior members of the profession” (WHO, p.58). In the Nigerian setting, most of the nurse educators or tutors rarely have interest in or posssess adequate training in psychiatric nursing. So high is the stigma attached to
INTEGRATIONOFiUENTALHEALTHCONCEFTSINNIGERiA
67
this branch of nursing that it is considered very unattractive. Consequently the deficiency in psychiatric education during basic nursing programmes can partly be attributed to a similar deficiency or lack of interest by the nurse educators. This can be remedied by providing continuing education for the tutors and other members of the profession. “Nursing education should be regarded as a continuing process, therefore, orientation programmes, inservice education and refresher courses should be organized systematically by the individual institutions and offkial bodies, at national, regional or local levels” (WHO, p.78).
It is most desirable that nurse educators in Nigeria, through the assistance of the Council, should be concerned with enriching and strengthening our basic nursing curriculum in order to prepare nurses who are capable of relating with all types of patients more effectively and therapeutically. Great pains must be taken on integrating mental health concepts as well as other preventive aspects of nursing, into basic nursing programmes. Such an incorporation, if successful, gives the nurse certain extra skills, in addition to basic skills of general nursing care. This goes a long way in enhancing the general nurse’s understanding and increased effectiveness in the application of her nursing skills in any clinical area, including psychiatric care. At the Department of Nursing of the University of Ibadan, attempts are being made to achieve these ideals. Although the course is postbasic, psychiatric nursing is being integrated into the Nursing Science courses throughout the 3 yr of the degree programme. This we hope will go a long way in helping to produce nurse practitioners and graduate nurse tutors who are capable of imparting mental health concepts to the future generation of nursing students. Nursing
Conclusions On’ the basis of this opinion survey, it seems that mental health concepts and psychiatric training are not being well integrated into general nursing education in Nigeria. The length of time (8 weeks) specified by the Nursing Council is not being complied with by many schools of nursing. Moreover the structure of the training seems inadequate. This deficiency is attributed to a lack of adequate clinical facilities, teaching personnel (nurse tutors) with training or interest in psychiatric nursing, and lastly, religious/cultural beliefs. Using occasional visits to mental hospitals as the main basis of clinical psychiatric experience seems unsatisfactory. The solution probably lies in the provision of several psychiatric units attached to hospitals where nursing students train. This will permit direct participation and day-to-day training in the treatment of mental health patients. In addition, training of students in community mental health nursing should be encouraged. The professional nursing bodies in the country should encourage every school of nursing to fully integrate psychiatric nursing into their basic curriculum. Indeed the time has come when every professional nurse, irrespective of her specialty, should have some acquaintance with the principles of mental hygiene and psychiatric nursing care. This can be achieved by organising continuing education programmes for nurses. A post-basic diploma course in psychiatric nursing (similar to that in midwifery) can be established to educate general nurses who desire more competence in mental health care. Universities and the Advanced Technical Teachers Colleges that train nurse tutors should be encouraged to integrate psychiatric nursing into their teaching curricula. Considering the acute shortage of psychiatrists in this country, it is the duty of the
68
ROSALINE A. OLADE
professional bodies and nurse educators to see that the nurses on whose shoulders primary mental health care is placed, are competently trained and capable of discharging their duties effkiently. References Federal Office of Statistics (1974). Annual Abstract of Statistics, Lagos, Nigeria. Nursing Council for Nigeria, Ministry of Health Lagos (196S). Report of a Special Joint Committee on New Standards of Nurse-Training in Nigeria. p.3. Pesznecker, B. and Hewitt, H. (1963). Psychiatric Content in the Nursing Curriculum. p.3. University of Washington Press, Seattle. World Health Organisation. The nurse in mental health practice. Public Health Papers No. 22, p.58. World Health Organisation. Public Health Papers No.22, p.78.
.I. NWS. Stud. Vol. 14, pp. 63.68, Pergamon
Press.
1977. Printed in Great Britain.
Integration of mental health concepts into general nursing education in Nigeria -A survey of nurses opinions ’
ROSALINE A. OLADE Department of Nursing, University of Ibadan, Ibadan. Nigeria
Introdaction Prior to 1965, the teaching of mental health nursing was not considered as a compulsory part of the basic nursing curriculum in diploma schools of nursing in Nigeria. The adoption of this compulsory requirement by the Nursing Council of Nigeria in 1965 was based on the recommendation of the Special Committee on New Standards of NurseTraining in Nigeria, Nursing Council for Nigeria (1965). It specified that “experience in the psychiatric field should be obtained in a ward unit of 12 beds, or alternatively approved special centre or outpatient department” (Nursing Council for Nigeria, 1965).
in an
For this purpose, 8 weeks are allocated for both theory and clinical experience in psychiatric nursing. Very few hospitals in this country can meet the clinical requirement of a 12-bed psychiatric unit. Moreover, approved special psychiatric centres or mental hospitals are very few and far apart. Because of this apparent lack of adequate clinical facilities, many diploma schools of nursing in Nigeria are forced to send their students for practical experience in the very few mental hospitals that possess clinical and some teaching facilities, such as Aro Mental Hospital near Abeokuta. This experience may take the form of either periodic visits or in-residence training for varying periods. Many nursing schools that cannot avail themselves of such facilities offer either no psychiatric training or teach only theoretical principles to the students. It is an admitted fact that mental care needs considerable improvement in this country. The impact of the so-called Western civilization as evidenced by rapid industrialization, increased rural-urban migrations, detribalixation and disruption of extended family systems, has increased mental stresses within the society. To ameliorate the situation the Federal Government has planned to construct more psychiatric units or hospitals, at least one in each state. The achievement of such a desirable goal will make mental health services more accessible to more people in all parts of the country. Considering the acute shortage of qualified psychiatrists in the country, nurses will 63
64
ROSALINE A. OLALIE
definitely play a very important role in the dispensation of mental health care in the proposed psychiatric institutions, as well as in the general community. Since we only have about 450 specially-trained psychiatric nurses (Registered Mental Nurses) in the country, Federal Office of Statistics (1974), it is obvious that general nurses will have to be employed to provide mental health care. The efficiency of this cadre of nurses in performing these necessary services strongly depends on the nature and extent of their psychiatric training. After more than a decade of introducing psychiatric nursing into general nursing curriculum in Nigeria, this paper investigates the opinion of nurses about their preparation for the role of providing efficient mental health care. Methodology This survey involved 73 registered general nurses who are presently undergoing postbasic nursing training at the Department of Nursing, University of Ibadan. They all possess at least a year of post-qualification experience, and obtained their nursing diplomas from various categories of hospitals in the country. Out of the group, 19 trained in missionary hospitals, 23 in general hospitals, and 31 in teaching hospitals. Fifty-one students or about 70% of the group entered diploma nursing schools in 1966 or thereafter. A questionnaire designed by the author was distributed to the students, requesting information about their category of training schools, the number of weeks used in learning psychiatric nursing (theory and/or practical). Also the questionnaire was set to inquire about the adequacy of the psychiatric experience and their general comments on psychiatric integration. Since the survey was designed to evaluate psychiatric integration into nursing curriculum in Nigeria, nurses who had their basic training overseas were excluded from the analysis of results.
Results of this survey are summarised in Tables 1 and 2. These are arranged according Table 1. The amount of psychiatric nursing experience which respondents had during basic training
Number of weeks of theoretical and clinical experience in psychiatry Training school o-2
WI
2-4
(%I
6-8
4-6
8-10
(N-l
(%)
(N)
(%I
09
(%)
(N)
1
10 - 12
w
(%)
4.4
3
13
(%I
General hospitals N=23
6
26
4
17.5
3
13
6
26
Missionary hospitals N=19
8
42
2
10.5
5
26
4
21
Teaching hospitals N=31
7
22.5
7
22.5
8
26
5
16
1
3.3
3
10
22
30
15
19
19
25
12
16
2
2.1
5
6.8
All hospitals N=l3
65
INTEGRATIONOFMENlA.LHEALTHCONCEPTSINNIGE~
to the category of hospital training schools, and length of theoretical and practical experience in psychiatric nursing. As evident in Table 1, the number of weeks of training ranges from 0 to 12 weeks. A histogram plot (not shown here) of the values shows a normal distribution with a median value of about 4 weeks. Considering the study population in detail, only 16% had up to 8 weeks psychiatric experience, which is the minimum period recommended by the Nursing Council. Slightly more than 30% were exposed to a maximum of 2 weeks or no psychiatric training at all. About 19% of the group had 2-4 weeks experience, while 25% had 4-6 weeks of psychiatric nursing, both theory and practical. It is however interesting to note that 9.5% of the study population claim to have obtained more than 8 weeks experience. This is probably attributable to the fact that other courses in nursing are commonly sandwiched or alternated with that of psychiatry. Consequently an overestimation in the length of psychiatric training, cannot be ruled out. Moreover, it is apparent in Table 1 that among the 30% who had less than 2 weeks training, almost half were trained in missionary hospitals. This may have something to do with religious attitudes to psychiatry. In addition the missionary nursing schools are most likely to be located in relatively more remote areas of the country, and because of their limited financial strength, they may not be able to avail themselves of the necessary expenses of bringing students to urban psychiatric centres. A summary of the opinions of the nurses with respect to the adequacy of their preparation for psychiatric nursing, is presented in Table 2. As expected, 100% of those who had less than 2 weeks psychiatric preparation felt it was inadequate, while one-third of those who had 6-8 weeks training considered it as just adequate. It is noteworthy that all of those who claimed a training of more than 8 weeks felt it was inadequate, which supports the earlier supposition that not all this period was used for psychiatric Table 2. Nurses opinions about the psychiatric nursing content of their basic training
Adequacy of preparation No. of weeks Very 8
Just
(%I
8
Not (%)
WI
(%I
o-2
0
0
0
0
22
100
2-4
0
0
1
6.1
14
93.3
4-6
0
0
1
5.2
18
94.8
6-8
0
0
4
33.3
8
66.1
8 - 10
0
0
0
0
2
100
0
0
3
60
2
40
10-12
experience alone. On the whole, 85% of the study population felt they were not adequately propared while 15% considered their preparation as just adequate. Surprisingly, not a single nurse felt very adequately prepared at the basic level to provide psychiatric nursing care.
66
ROSALINE A. OLALIE
Discussion Results presented above demonstrate that the majority of nurses examined in this survey consider their psychiatric experience during basic nursing training as inadequate. They however realize the usefulness and necessity of psychiatric nursing integration into basic nursing curiculum. This is evident from the comments made by these nurses in the free-response section of the questionnaire. They feel that it is very necessary to receive lectures in psychology which will enhance their understanding of psychiatric disorders. A knowledge of mental health concepts and psychology is not only necessary in the nursing of psychiatric patients but extremely useful for nursing man in his totality, in all aspects of nursing intervention. In fact ‘the socio-psychological components of nursing care have long been recognised as important in the care of patients, Pesznecker and Hewitt (1963). In our society, there is still a great deal of stigma attached to mental illness, even among nurses, especially general nurses who have little or no orientation to psychiatric nursing. The existence of such a stigma within the nursing profession can mar the efficiency of the nurses in the delivery of mental health care. Rather than becoming professional nurses who can interact with and take care of their patients, they may virtually turn out to be just ‘dispensers’ of medicines, which is not the only way of treating psychiatric disturbances. Most of the nurses examined in this survey recommend a better integration of mental health concepts and clinical training into the basic nursing curriculum. This will go a long way in dispelling the cultural belief among nurses about the ethiology of psychiatric disorders and thereby laying the foundation for the introduction of modern techniques of psychiatric nursing and treatments. Apart from complying with the minimum requirement of 8 weeks of psychiatric nursing education it is also essential that the theoretical and practical training should be given in a meaningful and most useful manner. Opinions obtained in this survey show bitter criticisms of the method of paying just observational visits to mental hospitals as a major component of the student’s psychiatric clinical experience. The fact is that, for most of these scheduled visits (usually once a week or fortnight), the patients are usually prepared or made aware of the oncoming visit. Thus the experience obtained by the students is not typical and often lacks direct student participation in the everyday care of the patients. Moreover, a lack of adequate hostel accommodation in the mental hospitals may not permit longer or extended visits by the students, when this is desirable. A closer look at the theoretical aspects of psychiatric orientation as given in most basic schools of nursing in Nigeria, reveals that most of the lectures are given by psychiatrists who are usually invited as guest lecturers. In most instances no laid-down syllabus is provided, and the nurses are taught more or less as medical students. While this pattern of teaching may be acceptable, the most important aspect to be stressed in psychiatric teaching of nurses is the ‘art’ of nursing the mental patients. A WHO Expert Committee noted that: “The modem nurse requires, first of all, an understanding of the mental, physical and social needs of all types of people both sick and well . . . . The teaching of these attitudes and skills is primarily the responsibility of nursing educators whether they be specially qualified nurse tutors or other senior members of the profession” (WHO, p.58). In the Nigerian setting, most of the nurse educators or tutors rarely have interest in or posssess adequate training in psychiatric nursing. So high is the stigma attached to
INTEGRATIONOFiUENTALHEALTHCONCEFTSINNIGERiA
67
this branch of nursing that it is considered very unattractive. Consequently the deficiency in psychiatric education during basic nursing programmes can partly be attributed to a similar deficiency or lack of interest by the nurse educators. This can be remedied by providing continuing education for the tutors and other members of the profession. “Nursing education should be regarded as a continuing process, therefore, orientation programmes, inservice education and refresher courses should be organized systematically by the individual institutions and offkial bodies, at national, regional or local levels” (WHO, p.78).
It is most desirable that nurse educators in Nigeria, through the assistance of the Council, should be concerned with enriching and strengthening our basic nursing curriculum in order to prepare nurses who are capable of relating with all types of patients more effectively and therapeutically. Great pains must be taken on integrating mental health concepts as well as other preventive aspects of nursing, into basic nursing programmes. Such an incorporation, if successful, gives the nurse certain extra skills, in addition to basic skills of general nursing care. This goes a long way in enhancing the general nurse’s understanding and increased effectiveness in the application of her nursing skills in any clinical area, including psychiatric care. At the Department of Nursing of the University of Ibadan, attempts are being made to achieve these ideals. Although the course is postbasic, psychiatric nursing is being integrated into the Nursing Science courses throughout the 3 yr of the degree programme. This we hope will go a long way in helping to produce nurse practitioners and graduate nurse tutors who are capable of imparting mental health concepts to the future generation of nursing students. Nursing
Conclusions On’ the basis of this opinion survey, it seems that mental health concepts and psychiatric training are not being well integrated into general nursing education in Nigeria. The length of time (8 weeks) specified by the Nursing Council is not being complied with by many schools of nursing. Moreover the structure of the training seems inadequate. This deficiency is attributed to a lack of adequate clinical facilities, teaching personnel (nurse tutors) with training or interest in psychiatric nursing, and lastly, religious/cultural beliefs. Using occasional visits to mental hospitals as the main basis of clinical psychiatric experience seems unsatisfactory. The solution probably lies in the provision of several psychiatric units attached to hospitals where nursing students train. This will permit direct participation and day-to-day training in the treatment of mental health patients. In addition, training of students in community mental health nursing should be encouraged. The professional nursing bodies in the country should encourage every school of nursing to fully integrate psychiatric nursing into their basic curriculum. Indeed the time has come when every professional nurse, irrespective of her specialty, should have some acquaintance with the principles of mental hygiene and psychiatric nursing care. This can be achieved by organising continuing education programmes for nurses. A post-basic diploma course in psychiatric nursing (similar to that in midwifery) can be established to educate general nurses who desire more competence in mental health care. Universities and the Advanced Technical Teachers Colleges that train nurse tutors should be encouraged to integrate psychiatric nursing into their teaching curricula. Considering the acute shortage of psychiatrists in this country, it is the duty of the
68
ROSALINE A. OLADE
professional bodies and nurse educators to see that the nurses on whose shoulders primary mental health care is placed, are competently trained and capable of discharging their duties effkiently. References Federal Office of Statistics (1974). Annual Abstract of Statistics, Lagos, Nigeria. Nursing Council for Nigeria, Ministry of Health Lagos (196S). Report of a Special Joint Committee on New Standards of Nurse-Training in Nigeria. p.3. Pesznecker, B. and Hewitt, H. (1963). Psychiatric Content in the Nursing Curriculum. p.3. University of Washington Press, Seattle. World Health Organisation. The nurse in mental health practice. Public Health Papers No. 22, p.58. World Health Organisation. Public Health Papers No.22, p.78.
