Investigation of the relationship between nurses’ levels of mental health literacy, holistic nursing competencies, and professional self-efficacy

Abstract

BACKGROUND

Given their responsibility for the well-being of individuals, nurses with advanced mental health literacy, along with strong holistic nursing competencies and professional self-efficacy, are better equipped to assess both the mental and physical health of their patients, leading to the provision of holistic nursing care.

AIM

To investigate the relationship between nurses’ mental health literacy levels and their holistic nursing competencies, as well as their nursing professional self-efficacy.

METHODS

This study is cross-sectional, correlational research. The study sample consisted of a total of 261 volunteer nurses working in a training and research hospital and a state hospital between March 11, 2024 and April 8, 2024. Data were collected face to face with the “Descriptive Data Form”, “Mental Health Literacy Scale (MHLS)”, “Holistic Nursing Competence Scale (HNCS)”, and the “Nursing Profession Self-Efficacy Scale (NPSES)”.

RESULTS

The mean scale scores for the nurses were as follows: MHLS: 95.88 ± 11.67; HNCS: 179.46 ± 33.82; NPSES: 64.79 ± 11.24. A low-level positive correlation was found between the total scores of the MHLS, HNCS, and NPSES, and a moderate-level positive correlation was observed between the total scores of the HNCS and NPSES. These correlations were statistically significant (P < 0.05).

CONCLUSION

It is recommended that initiatives be undertaken to enhance the mental health literacy and holistic nursing competencies of nurses and that similar studies be conducted with nurses in different institutions and with a larger number of nurses.

Key Words: Mental health; Literacy; Holistic; Competence; Nursing; Self-efficacy

Core Tip: This study found that nurses’ mental health literacy was low, while their holistic nursing competencies were rated as moderate, and their professional self-efficacy was high. In addition, an interesting finding of our study is the identification of a low positive correlation between the total scores of the Mental Health Literacy Scale, the Holistic Nursing Competence Scale, and the Nursing Profession Self-Efficacy Scale. In addition, a moderate positive correlation was found between total scores on the Holistic Nursing Competence Scale and Nursing Profession Self-Efficacy Scale. The regression analysis conducted to determine the cause and effect relationship between the scales was also found to be significant.

INTRODUCTION

The holistic approach involves evaluating an individual as an integrated whole, including his or her physical, mental, emotional, and sociocultural dimensions, all in interaction with his or her family and close circle. This holistic approach necessitates treating a patient not only as someone with a medical condition but as a “multifaceted whole” with all aspects taken into consideration[1-3]. Holistic nursing care, on the other hand, is a specialized nursing practice in which practitioners use their nursing knowledge, skills, and theory to both care for individuals and build therapeutic relationships[1,4,5]. Nurses who adopt this perspective promote health by recognizing the unique characteristics of each person and assessing their perceptions of health and illness, thus fostering a more realistic understanding[2,6].

Holistic nursing is used to describe nursing focus on the patient as a whole and patient-centered care. Holistic nursing is a nursing practice that deals with the complexities of human experience and is realized in an interdisciplinary and interprofessional team. Holistic nursing is an area of nursing practice in which nurses use the knowledge, skills, attitudes and theories they have learned about nursing for the care of individuals and the formation of therapeutic relationships[1,2,6]. It is known that the nurse who has a holistic perspective provides positive contributions such as self-recognition of the rehabilitated and treated individual, acceptance of the disease, evaluation of health-disease concepts and realization of its expression in his/her own body, shortening the recovery and treatment period, improving health, increasing quality of life, and receiving better quality care. Nurses who have holistic care competence and adopt a holistic care approach have many contributions such as increasing their professionalism, strengthening interpersonal and team member communication, increasing empathy skills and gaining personal-professional autonomy. In order to increase holistic care competence, it is important to provide adequate health professionals, to increase the quality of the environment for professional development, to provide adequate equipment, to increase technical facilities and to ensure job security[1,2,5].

Holistic care has positive contributions not only to patients and their families, but also to nurses, the broader healthcare team, and the institution[1,2]. In the context of holistic nursing, competence refers to integrating personal qualities, values, attitudes, and professional knowledge with nursing practices, all performed with a sense of professional responsibility[1,7,8]. Achieving this competence requires adherence to ethical standards in practice, continuing education for nurses and nursing students, effective management of human resources, and professional development[9]. It is anticipated that the consistent application of the holistic approach, not only in general health care but also in mental health care, and measuring the holistic competence levels of nurses and the cultivation of this approach in nurses will improve mental health services[2].

The concept of competence in holistic nursing is that the nurse fulfills his/her practices in this direction by knowing his/her personal characteristics, values, attitudes, knowledge and skills and being aware of his/her professional responsibilities[2]. Ensuring holistic nursing competence depends on conditions such as ethics-oriented practices, providing continuous education to nurses during student and professional life, managing the workforce, ensuring professional development and working in cooperation with team members[4]. In studies related to the holistic nursing competence of nurses, it was found that the competence of nurses increased as clinical experience and reward increased, while the competence of nurses decreased as the desire to leave the institution increased[4,6-8].

For patients to receive truly holistic nursing care, a comprehensive assessment of their mental health is essential, and subsequent nursing care must be provided accordingly. Nurses need to have a high level of mental health literacy when assessing patients’ mental well-being[10,11]. Mental health literacy refers to the knowledge and beliefs toward identifying, managing, and preventing mental disorders[12]. A high level of mental health literacy enables nurses to accurately assess the psychological state of their patients, identify mental health problems and potential suicidal or homicidal tendencies, and ensure the provision of effective treatment and care[10].

For nurses to provide holistic nursing care, they must have a high level of competence, based on the knowledge and skills necessary to provide quality care. Professional self-efficacy plays a critical role in enabling nurses to be successful and productive in their field[13]. Professional self-efficacy has a high impact on nurses. High self-efficacy is important for nurses to overcome the high stress levels, difficult working conditions and organizational constraints they face in the workplace, to increase job satisfaction and to reduce the thought of quitting the job. A higher self-efficacy in the nursing profession promotes both personal and professional growth in nurses and improves collaboration with team members and colleagues. In addition, nurses with high professional self-efficacy tend to provide better patient care, which ultimately improves the overall quality of care provided[14-16].

Given their responsibility for the well-being of individuals, nurses with advanced mental health literacy, along with strong holistic nursing competencies and professional self-efficacy, are better equipped to assess both the mental and physical health of their patients, leading to the provision of holistic nursing care. Therefore, investigating the relationship between nurses’ mental health literacy, holistic nursing competencies, and professional self-efficacy is considered critical. Since there is no study in the relevant literature examining the relationship between nurses’ mental health literacy levels and their holistic nursing competencies and nursing profession self-efficacy, this planned research has originality. It is expected that nurses with high mental health literacy will also demonstrate strong holistic nursing competencies and professional self-efficacy, leading to more holistic and effective patient care. In this context, this study aims to explore the relationships between nurses’ mental health literacy, holistic nursing competencies, and professional self-efficacy to facilitate the enhancement of nurses’ holistic and professional competencies.

MATERIALS AND METHODS

Study design

This study used a cross-sectional and correlational research design.

Participants

The study population consisted of nurses employed at a training and research hospital (645 nurses) and a state hospital (160 nurses) between March 11, 2024 and April 8, 2024 (n = 805). A total of 261 nurses who voluntarily participated and fully completed the data collection forms constituted the study sample (n = 261). According to the sample size calculation based on a power analysis with a 95% confidence level and a 5% margin of error, a minimum of 252 participants was required[17,18].

Data collection procedures

The study data were collected in person by the researcher at the designated hospitals to ensure minimal disruption to the nurses’ workflow by distributing questionnaires during times when nurses were available, and the face-to-face data collection process took approximately 10 minutes per participant.

Data collection instruments

The data collection instruments used in the study were as follows: The “Descriptive Data Form”, the “Mental Health Literacy Scale (MHLS)”, the “Holistic Nursing Competence Scale (HNCS)”, and the “Nursing Profession Self-Efficacy Scale (NPSES)”.

Descriptive data form

This form, designed by the researcher based on relevant literature[2,8,19], consists of 12 items. It collects information about the demographic and professional background of the nurses, including age, gender, educational background, years of employment, and the unit in which they work. The form also asks whether there is a history of diagnosed mental illness in their family and explores their perceptions of the impact of mental health knowledge on patient care, holistic nursing practice, and professional self-efficacy.

MHLS

The MHLS is designed to assess an individual’s level of mental health literacy, identify areas where support is needed, and evaluate the effectiveness of activities aimed at improving mental health literacy. Originally developed by O’Connor and Casey, the scale was adapted into Turkish by Tokur Kesgin et al[20]. The MHLS is a self-report instrument consisting of 35 items scored on a Likert scale. Items 1 to 15 use a four-point Likert scale, while items 16 to 35 use a five-point Likert scale. The total scale score is calculated by summing the scores of the responses. The lowest and highest scores on the scale are 35 and 160, respectively. In the Turkish validity and reliability study of the scale, its Cronbach’s alpha coefficient was found to be 0.89[20].

A study by Akgün et al[21] in 2022 identified a cut-off score of 109.50 for the Turkish population, with individuals scoring above this threshold classified as having a high level of mental health literacy. In their study, the Cronbach’s alpha coefficient was calculated as α = 0.84[21]. In this study, the total MHLS score was used with a cut-off score of 109.50. Those scoring above this cut-off score were considered to have high mental health literacy, and Cronbach’s alpha for the scale in this study was calculated to be α = 0.80.

HNCS

The HNCS, originally developed by Takase and Teraoka (2011), was adapted into Turkish by Aydın and Hiçdurmaz[4] in 2019. This instrument is a 7-point Likert-type scale, consisting of 36 items. The scale does not contain reverse-scored items or designated cut-off points, with higher scores indicating greater holistic nursing competence. In the validation and reliability study of the Turkish version of the scale, its Cronbach’s alpha coefficient was found to be 0.90[4]. In our study, the Cronbach’s alpha reliability coefficient for the scale was calculated as α = 0.95.

NPSES

The scale was developed by Caruso et al[22] in 2016 to assess the professional self-efficacy of nurses. Its Turkish adaptation was conducted by Kaçaroğlu Vicdan and Taştekin[15]. The NPSES is a 5-point Likert-type scale consisting of 16 items. The lowest and highest scores on the scale are 16 and 80, respectively. Higher scores indicate stronger professional self-efficacy. In the Turkish validity and reliability study, the scale’s Cronbach’s alpha coefficient was calculated as α = 0.87[15]. In our research, the Cronbach’s alpha for the NPSES was calculated to be α = 0.97.

Ethical considerations

Ethical approval was obtained from the Ethics Committee of a state university (Medical and Health Sciences Ethics Committee-2, Sports, Health, dated December 28, 2023, Decision No. 230156-165) before the start of the study. Institutional approval was obtained from the organization where the study was conducted, and permission to use the scales was granted by the respective authors, who adapted the scales into Turkish and conducted validity and reliability studies. Participants were selected voluntarily and were informed through an “Informed Consent Form”. Those who agreed to participate were included in the study, and their data were retained and analyzed confidentially. Participants were explicitly informed that participation was completely voluntary, that no identifying information would be collected, that they could withdraw from the study at any time, and that all information collected would remain confidential, and all participants were treated equally. The study was conducted following the ethical principles outlined in the “World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects, 2013/64” and the ethical standards for research and publication.

Statistical analysis

The study data were evaluated using IBM SPSS Statistics 25.0 (SPSS Inc., Chicago, IL, United States) software. Descriptive statistics, such as frequencies and percentages, were used to summarize the demographic characteristics of the nurses who participated in the study. The normality of the study data distribution was assessed using kurtosis and skewness values. As skewness values fell within the acceptable range of +3 to -3, analysis was continued using parametric tests. Analysis of variance was used for comparisons between three groups, and the t-test for comparisons between two groups. Since it was suitable for the data set, a post-hoc test (Tukey) was used to assess differences between groups. Relationships between scales were examined using Pearson correlation and linear regression analyses. Reliability analysis was made through the calculation of Cronbach’s alpha, and statistical significance was set at P < 0.05 with a 95% confidence interval[23].

RESULTS

Descriptive characteristics

Analysis of the descriptive characteristics of the participating nurses revealed that 69.3% were married, 84.7% had a bachelor’s degree, 46% had been employed for 1 to 11 years, and 37.9% were working in surgical units. Of these nurses, 87.4% reported no family history of diagnosed mental illness, 99.6% agreed that a holistic approach to nursing is important, and 95.4% agreed that knowledge of mental illness positively impacts patient care. Moreover, 97.3% felt that this knowledge enhanced their holistic approach to care, and 95.8% felt that it enhanced their professional self-efficacy.

The mean total scores on the MHLS, HNCS, and NPSES

When the mean total scores of the nurses in the study were analyzed, the following results were found: The MHLS had a mean score of 95.88 ± 11.67, the HNCS had a mean score of 179.46 ± 33.82, and the NPSES had a mean score of 64.79 ± 11.24 (Table 1).

Table 1 Distribution of total scores of nurses on the Mental Health Literacy Scale, Holistic Nursing Competence Scale and Nursing Profession Self-Efficacy Scale (n = 261).

Scale total score averages (minimum-maximum)	mean ± SD
Mental Health Literacy Scale (52-141)	95.88 ± 11.67
Holistic Nursing Competence Scale (36-252)	179.46 ± 33.82
Nursing Profession Self-Efficacy Scale (16-80)	64.79 ± 11.24

The differences between certain descriptive characteristics of the nurses and their mean total scale scores

Table 2 summarizes the findings regarding the differences between certain descriptive characteristics of the nurses and their mean total scale scores. According to these results, nurses aged 24-39 years (2.77 ± 0.33), males (2.85 ± 0.43), and those who considered the holistic approach important in nursing (3.57 ± 0.00) had higher mean MHLS scores. In addition, nurses with 22-31 years of experience had lower mean MHLS scores (2.66 ± 0.33) than those with 1-11 years of experience. In addition, the mean NPSES score of associate degree/vocational school of health graduates (3.67 ± 0.90) was lower than those who had bachelor’s degrees (4.09 ± 0.65). Nurses who believed that knowledge of mental health had a “negative impact” on their professional self-efficacy scored lower on the NPSES (3.99 ± 0.82) than those who believed that it had a “positive impact” on their professional self-efficacy (4.06 ± 0.68). These findings were statistically significant (P < 0.05) (Table 2).

Table 2 Differences between nurses’ descriptive characteristics and total mean scores of the Mental Health Literacy Scale, Holistic Nursing Competence Scale and Nursing Profession Self-Efficacy Scale (n = 261).

Characteristics	MHLS	HNCS	NPSES
Age (years), mean ± SD
24-39	2.77 ± 0.33	6.14 ± 1.20	6.14 ± 1.20
39-54	2.67 ± 0.32	6.27 ± 1.10	6.27 ± 1.10
Student t-test; P value	t = 2.253; P = 0.025	t = -0.864; P = 0.388	t = -0.864; P = 0.388
Gender, mean ± SD
Female	2.72 ± 0.31	6.20 ± 1.17	6.20 ± 1.17
Male	2.85 ± 0.43	6.08 ± 1.14	6.08 ± 1.14
Student t-test; P value	t = -2.06; P = 0.040	t = 0.503; P = 0.615	t = 0.503; P = 0.615
Last school graduated, mean ± SD
VSH/AS	2.67 ± 0.50	5.91 ± 1.16	3.67 ± 0.90
Bachelor’s degree	2.73 ± 0.29	6.21 ± 1.16	4.09 ± 0.65
Master’s degree	2.90 ± 0.42	6.29 ± 1.16	4.02 ± 0.78
Analysis of variation test; P value	F = 2.029; P = 0.134	F = 0.833; P = 0.436	F = 4.488; P = 0.012
Post-hoc	-	-	VSH/AS < bachelor’s degree
Working time (years), mean ± SD
1-11	2.79 ± 0.34	5.91 ± 1.16	4.06 ± 0.69
12-21	2.73 ± 0.27	6.21 ± 1.16	3.51 ± 1.06
22-31	2.66 ± 0.33	6.29 ± 1.16	3.89 ± 0.88
Analysis of variation test; P value	F = 3.792; P = 0.024	F = 0.833; P = 0.436	F = 1.390; P = 0.251
Post-hoc	22-31 < 1-11	-	-
Is a holistic approach important in nursing?
Yes	3.57 ± 0.00	6.18 ± 1.16	4.09 ± 0.63
No	2.73 ± 0.33	5.93 ± 0.00	3.99 ± 0.76
Student t-test; P value	t = -2.525; P = 0.012	t = 0.221; P = 0.826	t = 1.130; P = 0.260
How does nurses’ knowledge of mental illnesses affect their holistic nursing approaches?
Positive impact	2.73 ± 0.33	6.21 ± 1.16	4.06 ± 0.68
Negative impact	2.95 ± 0.53	5.57 ± 1.01	2.87 ± 1.02
It has no effect	3.50 ± 0.19	5.73 ± 0.83	3.99 ± 0.82
Analysis of variation test; P value	F = 1.156; P = 0.316	F = 2.586; P = 0.077	F = 4.396; P = 0.013
Post-hoc	-	-	Negative impact < positive impact

MHLS: Mental Health Literacy Scale; HNCS: Holistic Nursing Competence Scale; NPSES: Nursing Profession Self-Efficacy Scale; VSH/AS: Vocational school of health graduates/associate degree; Post-hoc: Tukey.

The correlations of mean total scores on the MHLS, HNCS, and NPSES

Pearson correlation analysis was used to examine the relationships between mean total scores on the MHLS, HNCS, and NPSES (Table 3). The results revealed a weak but positive correlation between the MHLS total score and the HNCS total score (r = 0.143, P = 0.021), and between the MHLS total score and the NPSES total score (r = 0.135, P = 0.030). In addition, a moderate positive correlation was observed between the HNCS total score and the NPSES total score (r = 0.373, P = 0.000). In addition, regression analysis was conducted to determine the cause and effect relationship between nurses’ mental health literacy levels, holistic nursing competencies, and nursing profession self-efficacy, and between holistic nursing competencies and nursing profession self-efficacy (Table 4).

Table 3 Relationship between total mean scores of nurses on the Mental Health Literacy Scale, Holistic Nursing Competence Scale and Nursing Profession Self-Efficacy Scale (n = 261).

Scales	r or P value	MHLS	HNCS	NPSES
MHLS	r	1	0.143a	0.135a
	P	-	0.021	0.030
HNCS	r	-	1	0.373a
	P	-	-	0.000
NPSES	r	-	-	1
	P	-	-	-

^aP < 0.05, Pearson correlation analysis.

MHLS: Mental Health Literacy Scale; HNCS: Holistic Nursing Competence Scale; NPSES: Nursing Profession Self-Efficacy Scale.

Table 4 Effects of mental health literacy levels of nurses on holistic nursing competencies and nursing profession self-efficacy, and the effects of holistic nursing competencies on nursing profession self-efficacy (n = 261).

Dependent variable	Independent variable	Non-standardized coefficients	β	t	P value	R2	Adj. R2	F
HNCS	Constant	166.737	-	9.522	0.000a	0.002	0.003	0.541
	MHLS	0.133	0.046	0.735	0.000a	-	-	-
NPSES	Constant	52.344	-	9.103	0.000a	0.018	0.014	4.758
	MHLS	0.130	0.135	2.181	0.000a	-	-	-
NPSES	Constant	42.530	-	12.153	0.000a	0.139	-	41.686
	HNCS	0.124	0.373	6.456	0.000a	-	0.136	-

^aP < 0.05.

R: Regression coefficient; MHLS: Mental Health Literacy Scale; HNCS: Holistic Nursing Competence Scale; NPSES: Nursing Profession Self-Efficacy Scale; Adj. R²: Adjusted R squared.

The regression analysis conducted to determine the cause and effect relationship between the nurses’ MHLS total score average and the HNCS total score average was found to be significant (F = 0.541; P = 0.000). When the regression analysis was examined, it was determined that the equation between HNCS and MHLS was; HNCS = 166.737 + 0.133 × MHLS and when MHLS increased by 1 unit, HNCS increased by 0.133 units. The regression analysis conducted to determine the cause and effect relationship between the nurses’ MHLS total score average and the NPSES total score average was found to be significant (F = 4.758; P = 0.000). When the regression analysis was examined, it was determined that the equation between NPSES and MHLS was; NPSES = 52.344 + 0.130 × MHLS and when the MHLS value increased by 1 unit, the NPSES value increased by 0.130 units. The regression analysis conducted to determine the cause and effect relationship between the nurses’ HNCS total score average and the NPSES total score average was found to be significant (F = 41.686; P = 0.000). When the regression analysis was examined, it was determined that the equation between NPSES and HNCS was NPSES = 42.530 + 0.124 × HNCS and when the HNCS value increases by 1 unit, the NPSES value increases by 0.124 units (Table 4).

DISCUSSION

In this study, which aimed to explore the relationship between mental health literacy, holistic nursing competencies, and self-efficacy among nurses, the mean total score of the MHLS for nurses was recorded at 95.88 ± 11.67, indicating that mental health literacy level in all the participating nurses was below the established cut-off score, suggesting that the participating nurses had low mental health literacy. However, one study indicated a moderate level of mental health literacy among nurses[24], while another study found a low level of mental health literacy among midwives[25]. Another study reported a low level of mental health literacy among nursing students[11]. The results of the previous research are in line with the results of our study. Low levels of mental health literacy can lead to delays in seeking health services and treatment, fear of stigma, and increased mental health problems[10]. Low mental health literacy among nurses means that they may struggle to conduct holistic assessments of the individuals in their care, hindering their ability to provide effective care.

Our study found that male nurses had higher levels of mental health literacy than female nurses. In contrast, previous studies reported that females typically have higher levels of mental health literacy than males[26,27]. Additionally, another study found no significant gender differences in mental health literacy at all[10]. Therefore, our findings represent a departure from the findings in the existing literature.

According to our research results, nurses between the ages of 24 and 39 had higher levels of mental health literacy than their counterparts 40 years and older. In addition, those with 1 to 11 years of experience had higher levels of mental health literacy than nurses with 22 to 31 years of experience. In one study, it was observed that the mental health literacy levels of nurses exhibited an increase with advancing age[24]. In another study, a similar trend was noted among the participants[10]. However, the results of our study diverge from those of the aforementioned studies.

As a result of our study, nurses who recognized the importance of a holistic approach were found to have higher levels of mental health literacy. Holistic nursing requires nurses to consider the individual as a whole, including physical, mental, spiritual, and social dimensions in their nursing interventions[1,7,8]. Consistent and adequate application of holistic principles is critical not only in general health but also in mental health. Identifying and enhancing nurses’ holistic competence can significantly advance healthcare services, covering both physical and mental well-being. The findings of our study and the relevant literature suggest that there is a mutually reinforcing relationship between nurses’ holistic nursing practices and their mental health literacy. It is believed that a strong foundation in holistic approaches and a high level of mental health literacy will enable nurses to provide holistic care to patients while promoting positive attitudes toward mental health conditions.

In our study, the total HNCS score of nurses was found to be 179.46 ± 33.82 and it is considered that the nurses had a medium level of holistic nursing competence. In previous studies[28,29], the holistic nursing competence of nurses was found to be high. In another study, 89% of nurses were found to have positive views regarding holistic nursing perception[30]. These studies are similar to our research results, and according to these findings, it is believed that nurses have good competence and awareness of holistic nursing.

In our study, the NPSES total score of nurses was found to be 64.79 ± 11.24 and it is considered that these nurses had high professional self-efficacy. Studies conducted so far have revealed that nurses have a good level of self-efficacy[31-33]. The results of our study are similar to the results of these aforementioned studies. From these findings, it is anticipated that the self-efficacy of nurses in the nursing profession is at a good level.

According to the results of our study, it was found that the mean NPSES score of nurses with bachelor’s degrees was higher than that of nurses with health vocational high school/associate degrees. In previous studies[34-36], the self-efficacy of nurses with bachelor’s or master’s degrees was found to be significantly higher than that of nurses with high school or associate degrees. The results of the previous research are in line with the results of our study. Thus, it is concluded that higher levels of education among nurses will increase their self-efficacy in the nursing profession. In addition, it was found that nurses who believed that having knowledge of mental illnesses positively influenced their professional self-efficacy had higher mean total NPSES scores. According to this result, it is believed that nurses’ knowledge of mental disorders and the holistic nursing approach will have a positive effect on increasing their professional self-efficacy in nursing.

The results of our study indicated a low positive correlation between the MHLS and HNCS total scores among nurses, and the regression analysis conducted to determine the cause-effect relationship between the MHLS total score average and the HNCS total score average was found to be significant. This result suggests that an increase in the mental health literacy of nurses will lead to an increase in their holistic nursing competencies. A nurse who can take a holistic approach views the patient as a whole within the context of his or her domain. Considering the physical, mental, emotional, and spiritual needs of individuals, nurses provide appropriate care that enables patients to manage their illness and improve their quality of life. To provide patient-centered and evidence-based holistic nursing care, nurses must have adequate competencies[37].

The implementation of a holistic approach is of great importance not only in the context of general health but also in the field of mental health, especially concerning the development of mental health services[2]. Increasing the mental health literacy of nurses contributes to the strengthening of mental health literacy at the societal level. A nurse with a high level of mental health literacy can educate patients, their families, and the general public about mental health disorders. Increasing nurses’ and society’s knowledge of mental disorders also leads to a reduction in stigmatizing attitudes toward individuals with mental illnesses[38-40]. A review of the literature revealed that no previous study had investigated nurses’ mental health literacy and holistic nursing competence. In a study conducted with nursing students[11], a positive correlation was found between the MHLS total score of nursing students and the HNCS general competence and professional development subfields, which is in line with our study findings.

The present study revealed a low positive correlation between the MHLS and NPSES total scores of the nurses, and the regression analysis conducted to determine the cause-effect relationship between the MHLS total score average and the NPSES total score average was found to be significant. In line with these findings, it is postulated that an increase in nurses’ mental health literacy will consequently lead to an increase in their self-efficacy within the nursing profession. A literature review revealed that no previous studies have investigated the relationship between nurses’ mental health literacy and their nursing self-efficacy. One study found a positive relationship between nurses’ perceived self-efficacy and problem-solving skills. Another study found a positive relationship between nurses’ professional self-efficacy and job satisfaction[41]. High levels of nurses’ professional self-efficacy enhance their personal and professional growth, foster better collaboration with colleagues, and improve the quality of patient care provided by nurses with higher professional self-efficacy[34-36].

The results of our study indicated a moderate positive correlation between the HNCS and the NPSES total scores of the nurses, and the regression analysis conducted to determine the cause-effect relationship between the HNCS total score average and the NPSES total score average was found to be significant. In light of these findings, it can be predicted that an increase in holistic nursing competencies among nurses will result in an increase in their self-efficacy in the nursing profession. One study found a positive relationship between nurses’ holistic nursing competencies and their patient-centered care competencies[28]. Holistic nursing care is defined as a distinct area of nursing practice in which nurses use their nursing knowledge, skills, and theories to provide care for healthy individuals or patients and to form therapeutic relationships[4,5]. Nurses competent in holistic nursing promote health by recognizing the importance of individual differences[2,6]. Effective holistic nursing has positive contributions to patients, their families, other nurses, team members, and the broader health services of the institution[1,2]. Based on a review of the relevant literature and our research findings, it can be concluded that improving nurses’ holistic nursing competencies is critical in increasing their self-efficacy in the nursing profession.

Limitations of the study

The fact that the study was conducted with nurses from only two institutions and the number of participating nurses is seen as a limitation. In addition, the results of this study are limited to the nurses who participated in the study and the data collection tools used in the study.

CONCLUSION

This study found that nurses’ mental health literacy was low, while their holistic nursing competencies were rated as moderate, and their professional self-efficacy was high. Specifically, nurses between the ages of 24 and 39, male nurses, and nurses with 1 to 11 years of professional experience were found to have higher levels of mental health literacy. In addition, nurses with a bachelor’s degree and those who believed that having knowledge of mental illnesses has a positive impact on their professional self-efficacy had higher levels of self-efficacy. In addition, an interesting finding in our study is the identification of a low positive correlation between the total scores of the MHLS, the HNCS, and the NPSES. Also, a moderate positive correlation was found between total scores on the HNCS and NPSES. The regression analysis conducted to determine the cause and effect relationship between the scales was also found to be significant. In line with these results, it is recommended that initiatives be undertaken to increase nurses’ mental health literacy levels and holistic nursing competencies, that nurses be trained on mental health literacy, mental health, psychiatric diseases and nursing approaches to patients with mental disorders, and that similar studies be conducted with nurses in different institutions and with a larger number of nurses.