Keeping the flame alight: understanding and enhancing interest in mental health nursing as a career

The Role of Self-Determined Motivation and the Potential for Pre-registration Student Learning: A Comparative Study within a Mental Health Clinical Placement

Developing therapeutic relationship skills as well as clinical skill confidence is critical for nursing students. While the nursing literature has examined multiple factors that influence student learning, little is known about the role of student motivation in skill development in non-traditional placement settings. Although therapeutic skills and clinical confidence are vital across a variety of contexts, here we focus on its development in mental health settings. The present study aimed to investigate whether the motivational profiles of nursing students varied with the learning associated with developing (1) a therapeutic relationship in mental health and (2) mental health clinical confidence. We examined students' self-determined motivation and skill development within an immersive, work-integrated learning experience. Undergraduate nursing students (n = 279) engaged in five-day mental health clinical placement, "Recovery Camp," as part of their studies. Data were collected via the Work Task Motivation Scale, Therapeutic Relationship Scale and the Mental Health Clinical Confidence Scale. Students were ranked into either high (top-third), moderate (mid-third) or low (bottom-third) motivation-level groups. These groups were compared for differences in Therapeutic Relationship and Mental Health Clinical Confidence scores. Students higher in motivation reported significantly higher therapeutic relationship skills (Positive Collaboration, p < .001; Emotional Difficulties, p < .01). Increased student motivation was also associated with greater clinical confidence compared to each lower-ranked motivation group (p ≤ .05). Our findings show that student motivation plays a meaningful role in pre-registration learning. Non-traditional learning environments may be uniquely placed to influence student motivation and enhance learning outcomes.

Standing out on the Margins: Using Dialogical Narrative Analysis to Explore Mental Health Student Nurse Identity Construction and Core Modules

Literature and experience suggest that student mental health nurses feel marginalised in core modules. A focus group was held to explore mental health nurse students' experiences of whole cohort core modules in nursing. Students from a university in the North of England attended a one hour focus group followed by dialogical narrative analysis of transcripts. Stories of shared professional identity, marginal status, critical thinking, and practical application of theory were shared by the group. Greater presence of mental health stakeholders earlier in the programme and more applied field specific teaching offer a means to bolster professional identity in mental health nursing students.

Nurses’ experiences of the causes of their lack of interest in working in psychiatric wards: a qualitative study

Background

The shortage of psychiatric nurses is a major healthcare challenge. Lack of interest (LOI) contributes to the shortage of psychiatric nurses. Nonetheless, there are limited studies in this area. The present study was conducted to explore nurses’ experiences of the causes of their LOI in working in psychiatric wards.

Methods

This qualitative study was conducted in 2016–2019 using the content analysis approach. Participants were 27 nurses purposively recruited with maximum variation from the psychiatric wards of three referral hospitals in Iran. Data were collected via unstructured interviews and were concurrently analyzed using the conventional content analysis approach recommended by Graneheim and Lundman.

Results

The causes of participants’ LOI in working in psychiatric wards were grouped into three main categories, namely inadequate professional skills for psychiatric care practice, negative public attitude towards psychiatric nurses, and concerns over patients.

Conclusion

This study suggests that the causes of nurses’ LOI in working in psychiatric wards are not only personal, but also social and organizational. Findings help managers and authorities develop strategies to increase psychiatric nurses’ interest in working in psychiatric wards through improving their work conditions and professional knowledge and skills.

Nurses' experiences of the causes of their lack of interest in working in psychiatric wards: a qualitative study

BACKGROUND

The shortage of psychiatric nurses is a major healthcare challenge. Lack of interest (LOI) contributes to the shortage of psychiatric nurses. Nonetheless, there are limited studies in this area. The present study was conducted to explore nurses' experiences of the causes of their LOI in working in psychiatric wards.

METHODS

This qualitative study was conducted in 2016-2019 using the content analysis approach. Participants were 27 nurses purposively recruited with maximum variation from the psychiatric wards of three referral hospitals in Iran. Data were collected via unstructured interviews and were concurrently analyzed using the conventional content analysis approach recommended by Graneheim and Lundman.

RESULTS

The causes of participants' LOI in working in psychiatric wards were grouped into three main categories, namely inadequate professional skills for psychiatric care practice, negative public attitude towards psychiatric nurses, and concerns over patients.

CONCLUSION

This study suggests that the causes of nurses' LOI in working in psychiatric wards are not only personal, but also social and organizational. Findings help managers and authorities develop strategies to increase psychiatric nurses' interest in working in psychiatric wards through improving their work conditions and professional knowledge and skills.

The clinical practice experience in psychiatric clinic of nursing students and career intention in China: A qualitative study

BACKGROUND

Nursing students face a lot of complicated situations and problems when they participate in psychiatric clinical practice for the first time. However, the nursing students' internship experience and career intention in psychiatry have not been well described in China.

PURPOSE

This study aims to explore the experience and career intention of Chinese nursing undergraduates during their first psychiatric internship.

METHOD

This is a qualitative design using phenomenological approach. Data were collected through a case-study, semi-structured, two face-to-face in-depth interviews (N = 13) with third-year nursing students from a university in China on their first clinical internship in a psychiatric department. We followed the consolidated criteria for reporting qualitative research (COREQ) checklist.

RESULTS

Four themes were identified: negative stereotype perceptions about mental illness, professional maturation, personal development, attitude towards psychiatric patients and career choice.

CONCLUSIONS

The experience of nursing students in psychiatric clinical practice was constantly changing. This study indicated that nursing students went through a continuous development process of psychiatric care professional maturation and personal development. However, psychiatric nursing was not an ideal career choice of nursing students. This study provides guidance for educators to optimize the internship experience and take comprehensive measures to improve the professional attractiveness and professional identity of psychiatric nursing.

The effect of a peer education program on nursing students' beliefs toward mental illnesses and their career choices

PURPOSE

The aim of this study was to investigate the effect of a peer education program on nursing students' beliefs toward mental illnesses and their career choices. DESIGN AND METHODS: This one-group quasi-experimental study was conducted with 95 undergraduate nursing students.

FINDINGS

The peer education program positively affected nursing students' beliefs toward mental illnesses (p < 0.005). It was determined that the students preferred psychiatric nursing more as a career field after the peer education program. PRACTICE IMPLICATIONS: Peer education programs may be a part of the nursing curriculum in combating stigma toward mental illnesses.

Battling Associative Stigma in Psychiatric Nursing

Psychiatric nurses often experience associative stigma. Associative stigma may impact psychiatric nurses' views of their professional identity which ultimately impacts the health care of individuals experiencing mental health concerns. Very little research has been conducted on associative stigma in the western Prairie Provinces, including Manitoba. The authors conducted a secondary analysis on the results of an explanatory sequential mixed methods research study to determine if psychiatric nurses in Manitoba are influenced by associative stigma. Three themes were identified through this analysis, specifically: (1) the perception that RPNs are not "Real" Nurses; (2) lack of recognition of specialized training; and (3) working with a stigmatized population. Associative stigma was intertwined in all of the participants' narratives indicating a need to dismantle associative stigma. Strategies to enhance the public perception of psychiatric nursing and decrease associative stigma within the profession are described.

Expert by Experience Involvement in Mental Health Nursing Education: Nursing Students' Perspectives on Potential Improvements

Expert by experience involvement in mental health education for health professional programmes has increased in recent decades. The related literature has articulated the benefits, and changes in attitudes have been measured in some studies. Less attention has been devoted to ways this learning approach could be improved. The aim of this paper is to present the nursing students perspectives on how Expert by Experience input into nursing curricula could be enhanced. Qualitative exploratory research was undertaken, involving focus groups with students who had completed a mental health learning module co-produced by Experts by Experience and nurse academics. Results show two main themes: getting the structure right, and changes to content and approach. Some student responses could directly influence changes to the learning module. In other instances, responses indicate the need to better prepare students of the value of lived experience knowledge in its own right, rather than adjunct to more traditional methods of education. These findings are important in encouraging reflection on how future learning modules co-produced by Experts by Experience and Mental Health Nursing academics can be refined and better articulated.

Undergraduate student nurses' perspectives of an integrated clinical learning model in the mental health environment

Providing nursing students with appropriate clinical practice during their undergraduate programme is critical to ensuring that graduates meet the competency requirements to gain registration as a nurse. In response to the predicted nursing workforce shortage, universities have been significantly increasing the enrolment of undergraduate nurses into Bachelor of Nursing courses. This has placed a demand on the availability of clinical placements and often universities struggle to find appropriate places. In this study, a Bachelor of Nursing course incorporated an Integrated Clinical Learning Model (ICLM) for the first time during a mental health placement. The model offered students the flexibility of attending their clinical placement over a 16-week period instead of a traditional block of 4 weeks. The aim of this study was to evaluate the student perspective of this model and whether it prepared them for the nursing workforce. Focus groups were conducted with undergraduate nursing students following their mental health clinical placement at an acute and extended care inpatient unit. Data were analysed using thematic analysis. Main themes included preparedness for practice, maintaining a work-life balance, and perceiving they were part of a team. The ICLM deepened students' knowledge and had a positive impact on their overall clinical learning.

Promoting the Value of Mental Health Nursing: The Contribution of a Consumer Academic

Mental illness is known to occur frequently in the general population and is more common within the general health care system. High-quality health care requires nurses to have the skills, knowledge and attitudes to provide care for people experiencing mental illness or mental distress. Research suggests health professionals, including nurses, tend to share similar negative attitudes to mental illness as the general population, and consequently, mental health nursing is not a popular career path. These two factors signify a need to influence more positive attitudes toward mental illness and mental health nursing among nursing students. A qualitative exploratory research study was undertaken to examine the experiences, opinions and attitudes of an academic and research team to the introduction of a consumer academic within an undergraduate mental health nursing subject. In-depth interviews were conducted with teaching and research team members. The importance of mental health skills emerged as a major theme and included sub-themes: mental health across the health care system; contribution of consumer academic to nursing skills; addressing fear and stigma, and inspiring passion in mental health nursing. Findings suggest academic input from people with lived experience of recovery from mental illness can influence the development of mental health nursing skills and enhance the popularity of mental health nursing as a career.

Preceptors' perspectives of an integrated clinical learning model in a mental health environment

Supervised clinical practice is an essential component of undergraduate nursing students' learning and development. In the mental health setting, nursing students traditionally undertake four-week block placements. An integrated clinical learning model, where preceptors mentor students on an individual basis, has been used successfully in the clinical learning environment. This flexible model provides the opportunity for students to work across morning, afternoon, night and weekend shifts. There is a need to improve the evidence base for a flexible model for students undertaking a mental health placement. The aim of this study was to understand preceptors' experience of, and satisfaction with, a mental health integrated clinical learning model. Focus groups were used to elicit the views of preceptors from a mental health service. Findings highlight the advantages and disadvantages of an integrated clinical learning model in the mental health setting. Participants suggested that students may benefit from flexible work arrangements, a variety of experiences and a more realistic experience of working in a mental health service. However, they found it challenging to mentor and evaluate students under this model. Most also agreed that the model impeded students' ability to engage with consumers and develop rapport with staff. The findings indicate the need to develop a placement model that meets the unique needs of the mental health setting.

The Mental health Master Class: An innovative approach to improving student learning in mental health nursing

The Master Class was developed as an additional educational innovation designed to promote learning about mental health and illness and mental health nursing as a career option to 2nd-year undergraduate nursing students. A number of students had approached the mental health nursing academics expressing two polar views on mental health. They either expressed extreme interest in mental health nursing or significant distress and concern related to studying the core 2nd-year subject. It was considered that the Master Class could potentially provide students with additional support. It was thought the Master Class may either consolidate their interest in mental health or relieve their stress. This article presents the findings of a pre- and postevaluation which was employed to explore the effectiveness of the 5-day intensive mental health Master Class programme on student's mental health learning and their understanding of the role of a mental health nurse. The findings highlighted that prior to participating in the Master Class, there was a significant sense of uncertainty associated with perceived levels of competence required within the profession of mental health nursing. This was coupled with students expressing they wanted to disengage with the profession even before they had commenced any theory or clinical experience. The post-Master Class findings illustrated a significant improvement in students desire to consider mental health nursing.

The Role of the Registered Nurse Working in Substance Use Disorder Treatment: A Hermeneutic Study

Substance Use Disorders (SUDs) are a national public health crisis. However, there is minimal existing research literature on the role of the nurse working in SUD treatment. The purpose of this study was to describe the meaning of the professional role of the registered nurse working in the SUD setting. The study utilized a Heideggerian Phenomenological approach with a modified Colaizzi method for analysis and interpretation. The nine study participants, two males and seven females, aged 27-60 had worked in SUD treatment for 1-37 years. Three major themes, with sub-themes, emerged: Defining the Role for Self; Learning the Role; and Navigating with Ease in an Unchangeable Culture. Findings demonstrated that nurses in SUD treatment value their role and the care of patients with SUDs. Patient recovery or relapse influenced job satisfaction. Significantly, the findings highlighted an outdated role with rigid boundaries and no real contemporary identity. Findings can be used to address the need for a contemporary SUD nursing identity and to support ongoing involvement of nurses in health policy related to SUDs.

Voices from the Field: Regional Nurses Speak About Motivations, Careers and How to Entice Others to Pursue Mental Health Nursing

The aims of this study are three-fold: determine the factors that motivate nurses to pursue mental health nursing; identify the strategies that might attract nursing students and practising nurses to pursue mental health nursing as a professional career; and identify the difficulties of nurses in achieving their preferred clinical specialty. A descriptive qualitative study design with semi-structured interviews was used. Fifteen mental health nurses from rural and regional South Australia were interviewed. Interviews were transcribed verbatim, and thematic analysis was undertaken. Of the fifteen participants, thirteen were females and two were males; their average age was 50 years. The factors that motivated the participants to pursue mental health nursing were categorized as intrinsic and extrinsic. There were many strategies that might attract nursing students and nurses to the field, but the most popular suggestion was the provision of high quality meaningful clinical placements. Other strategies were to convey the personal satisfaction derived from being a mental health nurse, promote mental health nursing aggressively, and provide employment incentives. The study also highlighted the importance of addressing stigma, and greater education and support for nurses to pursue a mental health career.

Exploration of the Factors Affecting the Choices of Nursing Students Who Choose Psychiatric Nursing as the First and Last Choice

The aim of this qualitative study was to explore the factors that affect the choices of nursing students who chose a psychiatric nursing internship. The sample group of the study consisted of 13 students who listed psychiatric nursing as their first choice and 11 students who listed psychiatric nursing as their last choice. Four themes were determined: personal reasons, stigmatization, experiences related to psychiatric nursing, and perception of care. Providing activities in nursing education to reduce stigmatization and increasing the time allocated for psychiatric nursing theory and practice are recommended.

Don't Just Survive, Thrive: Understanding How Acute Psychiatric Nurses Develop Resilience

With one in five Canadians estimated to experience mental illness, retention of registered nurses in the acute psychiatric hospital setting becomes a pressing issue. The key for these nurses to survive and potentially even thrive in practice has been identified as resilience. From interviews with four registered nurses, maintaining a "vast" perspective, becoming an "expert" of self, clarifying "belief systems", and being "present" through "staying awake" were identified as key in developing resilience. Although participants expressed that the development of resilience is an individual process, the concept of development was similar. Developing personal resilience may be a matter of self-development.

Undergraduate Nursing Students' Understandings of Mental Health: A Review of the Literature

The purpose of this literature review was to identify research and current literature surrounding nursing students' understandings of mental health. The aim is to share findings from an extensive international and national literature review exploring undergraduate nurse education specific to mental health content. Data were collected utilising a comprehensive search of electronic databases including CINAHL (EBSCO), MEDLINE, and PsycINFO 1987-(Ovid) from 2008 to 2016. The initial search terms were altered to include undergraduate, mental health, nursing, education, experience, and knowledge. Three content themes emerged which included: 1. Undergraduate nursing students' knowledge has been considered compromised due to concerns relating to the variation and inconsistencies within the comprehensive nursing curriculums representation of mental health, 2. Undergraduate nursing students knowledge of mental health is thought to be compromised due to the quality of mental health theoretical and experiential learning opportunities, and 3. Research indicates that nursing students' knowledge of mental health was influenced by their experience of undertaking mental health content. Based on these findings greater consideration of students' understandings of mental health is required.

[The Psychosocial Adaptation Process of Psychiatric Nurses Working in Community Mental Health Centers]

PURPOSE

The aim of this study was to verify psychosocial issues faced by psychiatric and community mental health nurse practitioners (PCMHNP) working in community mental health centers, and to identify the adaptation processes used to resolve the issues.

METHODS

Data were collected through in-depth interviews between December 2013 and August 2014. Participants were 11 PCMHNP working in community mental health centers. Analysis was done using the grounded theory methodology. The first question was "How did you start working at a community mental health center; what were the difficulties you faced during your employment and how did you resolve them?"

RESULTS

The core category was 'regulating within relationships.' The adaptation process was categorized into three sequential stages: 'nesting,' 'hanging around the nest,' and 'settling into the nest.' Various action/interaction strategies were employed in these stages. The adaptation results from using these strategies were 'psychiatric nursing within life' and 'a long way to go.'

CONCLUSION

The results of this study are significant as they aid in understanding the psychosocial adaptation processes of PCMHNP working in community mental health centers, and indicate areas to be addressed in the future in order for PCMHNP to fulfill their professional role in the local community.

Lived experience in teaching mental health nursing: issues of fear and power

Australian mental health policy clearly articulates recovery focus as the underpinning of mental health services. Barriers to achieving a recovery focus are identified in the literature, with negative attitudes of health professionals receiving particular attention. The involvement of people with lived experience of significant mental health challenges and mental health service use is essential to enhancing more positive attitudes. Lived-experience involvement in the education of nurses is evident; however, it is generally limited and implemented on an ad hoc basis. Overall, there is a paucity of literature on this topic. A qualitative exploratory study was undertaken to elicit the views and perceptions of nurse academics and lived-experience educators about the inclusion of lived experience in mental health nursing education. One major theme to emerge from the research was issues of fear and power, which included three subthemes: facing fear, demystifying mental illness, and issues of power. Lived-experience involvement has an important role to play in the education of nurses in addressing fear and demystifying the experience of mental illness. The power that lived-experience educators exercised in their roles varied considerably, and for many, was limited. Therefore, the effectiveness of lived-experience involvement requires a more equitable distribution of power.

Nursing students' attitudes about psychiatric mental health nursing

The purpose of this study was to describe Masters entry nursing students' attitudes about psychiatric mental health clinical experiences; preparedness to care for persons with mental illness; students' perceived stigmas and stereotypes; and plans to choose mental health nursing as a career. A 31-item survey was administered to pre-licensure graduate nursing students who were recruited from a Masters entry nursing program from a university in a large city in the Midwestern US. Results indicated that clinical experiences provide valuable experiences for nursing practice, however, fewer students think that these experiences prepare them to work as a psychiatric mental health nurse and none plan to pursue careers as psychiatric mental health nurses. The findings support conclusions from other studies that increasing the amount of time in the clinical setting and adding specific content to the curriculum, particularly content related to the importance of psychiatric mental health nursing and the effects of stigma, may assist the profession's efforts to recruit and retain psychiatric mental health nurses. Further research is needed to determine the effectiveness of these strategies and to identify the best ways to implement them.