Nursing student attitudes to people labelled with 'mental illness' and consumer participation: A survey-based analysis of findings and psychometric properties

A Scoping Review of Australian New Graduate Nurse Preparation to Work in Mental Health Settings

Objectives: The review explores current evidence on Australian pre-registration nurse education in preparing graduates to work in mental health settings, from the perspectives of the graduates. Design: A scoping review using the Joanna Briggs Institute framework for scoping reviews and the Preferred Reporting Items for Systematic and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was undertaken. Results: There were 31 eligible publications, reporting 12 qualitative studies, eight surveys and 11 quasi-experimental studies. All were in English language peer reviewed journals, published between 2000 and July 2023. Five themes emerged: 1. Well-organised and supported clinical placements can reduce stigma; 2. Student concerns regarding mental health clinical placements can be lessened when placements are well-designed; 3. Well-organised and resourced clinical placements can increase interest in mental health nursing; 4. Simulation learning can increase confidence during clinical placements; 5. Teaching by Experts By Experience (EBE) can reduce stigma and improved student attitudes. Conclusion: Evidence from 31 eligible publications indicated that properly resourced, purpose-designed theoretical and clinical learning experiences can be effective in reducing stigmatising attitudes and behaviours in pre-registration nursing students. Involving EBEs in mental health teaching is an important, but so far under-utilised, development in pre-registration nursing programmes in Australia.

Working effectively with consumers: Perspectives from students, teachers, nurses, and consumers

Preparing enrolled nurses (ENs) to effectively work with mental health consumers is crucial to meeting Australia's healthcare demands. This qualitative study aimed to explore various stakeholders' perceptions regarding the mental health knowledge, skills, and attributes (KSAs) required by ENs to engage with individuals experiencing mental health issues, thus guiding future training priorities. The sample comprised 44 participants including 18 students, 3 graduate ENs, 5 experienced ENs, 5 registered nurses (RNs), 4 nurse unit managers (NUMs), 5 teachers, and 5 consumers of mental health services. Focus groups were used to collect data from the students, whilst individual interviews were conducted with all other participants. A thematic analysis revealed communication was the most vital skill for effectively working with mental health consumers. Skills such as critical thinking and clinical reasoning were also deemed crucial, given the volatile nature of the mental health inpatient environment, necessitating effective responses to acute escalations to prevent adverse outcomes for both staff and consumers. Essential knowledge components included understanding mental health disorders, symptoms, and treatments, particularly medications used for mental health issues. Participants also emphasised the importance of attributes like confidence and empathy in supporting and caring for consumers, who often experienced trauma and vulnerability. These findings provide valuable insights into the content that should be incorporated into the diploma of nursing (DN) training to produce competent graduate ENs.

Decreasing Prejudicial Attitudes of Fear and Avoidance Toward Those Who Live with a Mental Illness-A Quasi-Experimental Controlled Study

The undergraduate mental health nursing course is an optimal time to address stigma and prejudice, while developing positive student attitudes toward those who live with mental health conditions. A quasi-experimental, pretest-posttest, nonequivalent-group study with a sample of undergraduate nursing students in New York City (N = 126) was conducted to determine the impact of an undergraduate mental health nursing course on attitudes toward people living with a general mental illness, depression, or schizophrenia. The intervention resulted in a significant reduction in total prejudice scores toward those with a general mental illness when compared to the control (p = 0.033, partial η2 = 0.062). The intervention had no significant impact on total prejudice scores regarding those with depression, or schizophrenia. Subscale analysis revealed the intervention significantly reduced attitudes of fear/avoidance regarding general mental illness (p = 0.040, partial η2 = 0.058) and schizophrenia (p < 0.001, partial η2 = 0.164). There was no impact on authoritarian or malevolent attitudes. Though some attitudes were not amenable to change, this study provides evidence that positive attitudes can be cultivated through undergraduate nursing education. Curricular reform is needed to reduce all facets of prejudice and best prepare future nurses to care for those with mental health conditions.

Creating successful patient partnerships in healthcare education to potentially improve students' understanding of patient-centered care

Healthcare systems around the world are constantly evolving to meet the diverse needs of the people they serve. Patient-centered care is recognized as a crucial element in providing high-quality care (Najafizada et al., 2021; Anderson & Gagliardi, 2021; Kwame & Petrucka, 2021). However, there is a recognized need to enhance patient-centered care's application in practice (Edgman-Levitan & Schoenbaum, 2021; Macarthur et al., 2021). To improve healthcare students' understanding of patient-centered care in practice, educational institutions can adopt innovative approaches to teaching. One strategy that shows promise is to include patient partners in the education of healthcare curricula (Merav and Ohad, 2017; Jury, 2022). By engaging patient partners, students can gain valuable insights into the care needs of individuals living with various conditions and then hopefully implement that into their practice. To effectively involve patient partners in healthcare curricula, educational organizations should establish patient partnership programs that foster meaningful collaboration. Involving patient partners in the creation, design, delivery, and evaluation of patient partnership programs may enhance partnerships and sustain active participation. Through collaborative efforts with patient partners, educational institutions can create policies that support and prioritize patient engagement, ultimately enriching the learning experience for students and promoting patient-centered care in practice.

Consumer Involvement in Psychiatric Nursing Education: An Analysis of South Korean Students' Experiences

This study examined the experiences of South Korean nursing students in a psychiatric nursing class with consumer involvement. Data on 98 nursing students were collected in June 2021 and analysed using content analysis of participants' journals. Our qualitative study design adheres to the COREQ checklist for qualitative studies. Four main categories and subcategories were identified: (1) reflection, (2) learning, (3) preparation for the future, and (4) requirements. The findings demonstrated that applying consumer involvement to psychiatric nursing education is an innovative and effective strategy to correct negative prejudices among nursing students against people with mental illness.

Analyzing the relationship between the personality traits of nursing students and their attitudes toward people with mental illnesses

PURPOSE

The aim is to analyze the relationship between the personality traits of nursing students and their attitudes toward people with mental illnesses.

DESIGN AND METHODS

The cross-sectional study constituted of 281 students. The Community Attitudes toward the Mentally Ill Scale and the Ten-Item Personality Inventory were used.

FINDINGS

The students who have mental illnesses or in their families showed a higher goodwill score. The openness to experience subscale was correlated with conscientiousness, extraversion, emotional stability, and agreeableness.

PRACTICE IMPLICATIONS

Organizing educational programs for nursing students focusing on developing a positive attitude toward people with mental illnesses is crucial.

The use and quality of reporting of Rasch analysis in nursing research: A methodological scoping review

BACKGROUND

Rasch analysis is widely used in the life sciences. Rasch analysis is a mathematical and probabilistic model based on the assumption that the probability of passing a single item is governed by a person's ability and the difficulty of the item. However, its use in nursing science remains unclear.

AIM

To (i) describe the use of Rasch analysis in nursing research and (ii) determine the quality of reporting in nursing studies using Rasch models.

METHODS

A methodological scoping review of literature was conducted. The systematic electronic literature search was initially conducted on 1 February 2020 and updated on 16 April 2021 from PubMed/Medline and CINAHL databases. The search was limited to covering the timeframe from the earliest literature available until 31 December 2020. The search terms used were Rasch, IRT, item response theory, and nursing. The search was limited to the English language and title/abstract level. The analysis included quantification and content analysis.

RESULTS

In total, 388 hits were identified. Following a two-phase retrieval process, 88 articles were included in the final analysis. Rasch analysis was used to test the psychometric properties of the newly developed instrument, and validate or test a short version of the existing instrument. The reporting of Rasch analysis demonstrated large variability in quality. Rating scale functioning, internal scale validity using goodness-of-fit statistics, and unidimensionality were the most frequently reported outcomes.

CONCLUSION

The use of Rasch analysis in nursing science was found to be unsystematic. Rasch analysis could provide new possibilities for investigating measurement properties. However, robust, comprehensive, and precise reporting of the methodological choices and results of Rasch analysis is needed. Furthermore, the use of Rasch analysis in nursing science is encouraged.

WHAT IS ALREADY KNOWN

WHAT THIS PAPER ADDS.

Stigma towards Mental Disorders among Nursing Students and Professionals: A Bibliometric Analysis

Stigma is one of the main barriers to prevention, treatment and recovery from mental illness. However, bibliometric studies in this area are still scarce. Therefore, our aim was to quantify and analyze the scientific literature on the stigma of nursing students and professionals towards mental disorders. To this purpose, bibliometric indicators of scientific production, impact and collaboration were used. Among our results, it stands out that only 14.3% of the total number of studies analyzed measure the efficacy of the interventions carried out to reduce stigma. Furthermore, with exceptions such as Happell B and Byrne L, collaborations between authors and institutions are limited. “Service user involvement” appeared as a prominent keyword in 2018, coinciding with the increase in publications on the effectiveness of interventions. Interventions based on the involvement of people with psychiatric diagnoses in the design of nursing curricula seem to become a promising line of research. More studies measuring the efficacy of such interventions are needed. Knowledge of the lines of research that are being developed and of the researchers and institutions involved can contribute to creating synergy between the different researchers and to continue adding projects to the existing ones, thus contributing to the generation of more robust results that show the most indicated interventions to reduce the still present stigma and improve care for people with psychiatric diagnoses.

[Understanding the lived experiences of undergraduate nursing students during a mental health practicum. An interpretive phenomenological analysis]

In a global context where populations' mental health needs are growing rapidly, recruiting the next generation of nurses to work in these care settings is particularly problematic. Because of their negative views on mental health issues, nursing students reject such a career path. According to the literature, training programs, particularly clinical immersions, are the main way of mitigating the unpopularity of mental health care among this new generation of nurses. Through an interpretive phenomenological analysis of semi-structured interviews conducted with eleven undergraduate nursing students, this research studied their learning experience during a clinical immersion in mental health care. Anchored in Parse's humanbecoming theory, this study explores the meaning that students attribute to such an experience, the experiential negotiation processes of the practicum setting, and the participants' ability to project themselves beyond the learning experience itself. These results raise various issues related to mental health nursing education, such as the importance of having a nursing role model, as well as various influencing factors related to the rejection of a career in mental health care by the next generation, such as the perception that working in these care settings involves an increased risk of aggression.

Locked versus open ward environments and restrictive measures in acute psychiatry in Greece: Nursing students' attitudes and experiences

PURPOSE

To examine student nurses' attitudes and experiences of door policies and restrictive measures in acute psychiatric care.

METHODS

A mixed-method study with 274 third-year students.

RESULTS

Participants' attitudes towards door locking and other containment measures appeared to be more a matter of custom, practice and tradition at particular units. The therapeutic benefits of open doors was the central organizing element in open units experiences while locked doors appeared to be "invisible" when the locked unit was perceived as a caring environment.

PRACTICAL IMPLICATIONS

Exploring student nurses' attitudes towards crucial and debatable aspects of mental health practice contributes in cultivating a critical and analytical attitude towards the service they provide necessary for supporting a recovery mental health model and building a strong professional identity.

Experiences of nursing students during clinical education in mental health clinics: A phenomenological qualitative study

AIM

Nursing students have both positive and negative experiences during clinical education. This study was conducted to identify experiences of nursing students during clinical education in mental health clinics.

DESIGN

This phenomenological qualitative design study was conducted with 4th year undergraduate nursing students from a university in Turkey to identify their experiences specifically in mental health clinics.

METHODS

The data were collected using focus groups interviews with 40 nursing students and assessed with the 7-stage phenomenological analysis method described by Colaizzi.

RESULTS

Three main themes were determined: (i) the need for supportive interventions to cope with negative emotions; (ii) difficulty in translating theoretical knowledge into practice; and (iii) the lack of role model nurses and teaching staff.

CONCLUSIONS

The results of this study indicate that supportive interventions should be given to nursing students before clinical education. Also, the duration of clinical education, the teaching methods to be used and role model nurses and teaching staff effectiveness in clinical education should be planned carefully.

[The unpopularity of mental health/psychiatry care settings among nursing students: A systematic review]

In every population and country around the world, mental health needs are great and are on the rise. Through their training and their vast field of expertise, nurses are an important lever for addressing the issue of accessibility in these care settings. While the increase in the number of new nursing graduates should have helped this issue, recent data show a sharp increase in the shortage of nurses in these care settings. This systematic review (n=40) using the CINAHL, MEDLINE, PsycArticles, and Scopus databases aims to explore why psychiatric and mental health care settings are unpopular with the next generation of nurses. Guided by Parse's theory, this review identifies three major themes : (1) nursing students' perspectives on mental health issues, (2) the influences of educational interventions on these perspectives, and (3) the factors facilitating and constraining a career in these care settings for new nursing graduates. These results enable a better understanding of what can affect the recruitment of new graduate nurses in mental health/psychiatry, while proposing various levers of intervention to specifically address this issue.

"I felt some prejudice in the back of my head": Nursing students' perspectives on learning about mental health from "Experts by Experience"

WHAT IS KNOWN ON THE SUBJECT?: Consumer participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal Involving mental health "Experts by Experience" in the education of nursing students demonstrates positive attitudinal change WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: More detailed understanding of nursing students' experiences and perspectives about being taught mental health nursing by "Experts by Experience" An international focus, extending understandings about how Experts by Experience might be perceived in a broader range of countries WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Positive attitudes towards people labelled with mental illness are essential for quality nursing practice Nurses have an important leadership role in facilitating consumer participation within health services. It is critical that their attitudes are professional and optimistic. ABSTRACT: Introduction Consumer participation is central to mental health policy. Negative attitudes of health professionals are barriers to realizing policy goals. Evidence suggests consumers (Experts by Experience) can influence positive attitudes in nursing students. Research in this area to date is limited and primarily from Australia and New Zealand. Aim To enhance understanding of nursing students' perspectives and experiences of being taught mental health by an Expert by Experience. Method A qualitative exploratory approach was used. Focus groups were conducted with nursing students from seven universities in Australia and Europe. Data were analysed thematically. Results Student participants described how exposure to Experts by Experience challenged their views and attitudes and provided a mechanism for reflection, critique and change. The main theme "changing mindset" includes two subthemes: exposing stereotypes and reflection. Discussion This unique international study demonstrates the capacity for Experts by Experience to contribute to positive attitudinal change towards mental illness in nursing students. This changed mindset must occur for policy goals to be realized. Implications for practice Nurses in all areas of practice will work with people labelled with mental illness and experiencing mental distress. Overcoming stereotypes and adopting more positive attitudes is essential to deliver quality mental health care.