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(p. 5). In Kennedy et al. (2013) ‘all [the] participants reported the training either added to their knowledge or refreshed existing knowledge which produced an improved sense of competence and knowledge’ (p. 335). The evaluation of a primary objective of the training namely, increasing the confidence in raising the topic of alcohol misuse with farm men and women, was achieved. The outcomes of the evaluation in Mellor et al. (2012) were mixed. Results showed that training had no impact on the intervention group’s mean score in perceived barriers, but the control group’s reduction at the post-training assessment was maintained at three month follow-up. However, there was an immediate positive impact (positive attitudes to working with people with alcohol problems) for the intervention group, but unexpectedly, both groups developed negative attitudes towards working with such clients by the 3 month follow-up. There was however a significant increase for the intervention nurses (greater than the controlled group) in the self-reported performance with clients with an alcohol problem. Lastly, over the course of the study the intervention group exhibited a significant increase concerning the frequency of engagement, while the control group exhibited no change from base line. 3.2.7 Discussion This literature review, in seeking to synthesise studies that examined the attitudes, perceptions and mental health training offered to rural and remote nurses, paints a relatively bleak picture of research findings. The four articles related to attitudes and perceptions have limited generalisability; Reed and Fitzgerald’s (2005) study was confined to two wards of a hospital and both Slaven and Kisely (2002) and Clark et al. (2005), while regional, were confined to a single Australian state. Participant numbers varied greatly