S.TRUEMAN PhD THESIS 2016

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argument is also consistent with generalist nurses in an urban setting (Bailey, 1998; Brady, 1976; Brinn, 2000). Reed and Fitzgerald (2005) advance the same theme, linking a lack of knowledge and negative feelings to stereotypical negative responses as identified by Rogers and Kashima (1998), who assert that education is an antidote to these nursing behaviours, whereby education enables the nurse to cease ‘inhibit[ing] automatic [negative] responses’ (Rogers & Kashima, 1998). Not surprisingly Reed and Fitzgerald (2005) advocate for mental health education for rural and remote nurses, as do Slaven and Kisely (2002) in relation to DSH. The question that arises then from this literature review is ‘are nurses in rural and remote locations being offered training, and is this training making a difference to the mental healthcare they provide?’ The level of discussion in the six papers reporting the provision of education and training varied greatly concerning the justification of content and means of evaluating the courses. All studies relied on a pre and post-test methodology except for Kennedy et al. (2013), which employed a follow-up qualitative interview (at two months), and Aoun and Johnson (2002) which undertook no pre-course testing resulting in baseline being at completion of the course. Most researchers based the course evaluation on a Likert scale or a variation thereof and again, justification, discussion and limitations were not expansively canvassed. Ellis and Philip (2010) undertook a pre and post-evaluation questionnaire with no discussion concerning design, which limits its value. While the evaluation results of both the quantitative and qualitative phases were significantly positive, there was a very significant level of sample attrition between pre ( n = 456) and post ( n = 163) without any explanation/ or discussion concerning possible bias. Dependability of the findings was strengthened with 44 follow-up interviews, which is a significant sample size for the