All nurses should have the ability and disposition to engage in therapeutic relations with people who have learning disabilities. Therapeutic commitment is described as a therapeutic attitude that is influenced by nurses' perceptions of role competency and role support. It is essential to the provision of nursing care leading to improved patient outcomes. The study aimed to explore final year adult (AD), mental health (MH) and learning disability (LD) student nurses' perceptions of therapeutic commitment towards people with learning disabilities and the factors they perceived influenced it. A mixed method, convergent approach for complementarity and expansion purposes was used. A survey collected quantitative and qualitative data from 398 final year student nurses across four Higher Education Institutes in Scotland. Integrated findings suggested when caring for people with learning disabilities that student nurses are therapeutically committed, with LD student nurses' perceptions being greater than their counterparts. LD student nurses also perceived greater role competency and reported they could access experienced support more readily. Having education, a personal experience, the opportunity to provide care whilst on clinical placement and previous work experience with people with learning disabilities influenced the therapeutic commitment and role competency all students perceived. Other influencing factors included receiving thanks, being challenged by the task and the attitudes and qualities held by the nurse. Some AD and MH student nurses believed that people with learning disabilities characteristics negatively influenced their therapeutic commitment. This study has implications for nursing practice and education as it builds on the theory of therapeutic commitment, providing new knowledge of the factors that influence it, either positively or negatively when caring for people with learning disabilities. This knowledge will support nurses to engage in positive therapeutic relationships with people with learning disabilities to enhance the delivery of nursing care.

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This study explored Canadian nurse practitioners’ (NPs) levels of therapeutic commitment (TC), role competency (RC) and role support (RS) when caring for persons with mental illness and mental health problems. Knowledge and experiential factors that impact these levels were examined and a model of therapeutic commitment was tested. A self-administered mail survey was sent to 1272 NPs from all Canadian jurisdictions except the Yukon, Saskatchewan and Quebec. The survey was comprised of the Mental Health Problem Perceptions Questionnaire (MHPPQ), demographic data and open-ended questions. Using Dillman’s Tailored Design Method, the target population was contacted 4 times: pre-notice letter, first survey, reminder letter, and repeat survey. Of the 1272 potential participants, 680 (57.2%) useable surveys were received. Out of a possible maximum score of 7, NPs reported mean levels of 5.05 (SD 0.83) on the TC, 5.02 (SD 0.88) on the RC and 4.86 (SD 1.27) on the RS subscales. As hypothesized, correlations between the three subscales were demonstrated with RC and TC being the most strongly associated (r = .754, p <.001). A composite variable, Confidence to Manage, which examined NPs’ confidence to manage 7 mental health disorders and suicide ideation was developed. Scores for this variable correlated with TC, RC and RS scores. Feeling ill-equipped to work with this population, knowledge of community mental health services, ratings of relevant theoretical and clinical NP education, previous mental health and NP work experience were all positively correlated with higher levels of the 4 subscales. Differences in categories for population size of the community the NP worked in, frequency of collaboration for psychiatric reasons, time since the NP accessed mental health education and highest level of nursing education were found to impact levels of TC, RS, RC and Confidence to Manage. A large number of NPs reported feeling inadequately prepared to manage the care of persons with mental illness and recommended either adding or increasing mental health education in their NP programs. Most NPs saw the care of this population as part of their role and acknowledged the need for increased support for persons with mental health issues.

The topic of substance-abuse has received increasing attention in recent years, as the number of individuals experiencing drug abuse and addiction is on the rise. With substance-use on the rise, the number of patients admitted to the hospital with this disorder is increasing also. It is important hospital staff are aware and educated on how to provide adequate care to these patients without judgement regarding their choices or their lifestyle. This study was done to determine how prepared nursing students are to care for patients with drug abuse or addiction. Specifically, the project explores student nurses' attitudes and commitment toward substance- abusing patients. The 20 item Drug and Drug Problem Perceptions Questionnaire (DDPPQ) was used to measure attitudes and therapeutic commitment in working with drug-abusing patients, and was distributed electronically to approximately 400 nursing students. One hundred thirty-one students participated. Scores ranged from 22-102, with the smaller value representing greater overall commitment and preparedness when working with substance-abusing patients. The mean score reported overall was 58. This score indicates improvement is needed to increase students' therapeutic commitment and ability to provide quality care for patients experiencing substance- abuse. More research needs to be done and programs put into place to reach this goal.