Nursing student attitudes to psychiatric nursing and psychiatric disorders in New Zealand

Exploring the experience of undergraduate nursing students following placement at psychiatric units in China: A phenomenological study

AIM

To explore undergraduate nursing students' experiences of psychiatric placements.

BACKGROUND

Placement is an important learning phase for undergraduate nursing students and the placement experiences may affect their career choices. However, nursing students' experiences of psychiatric placements have not been fully explored in China.

DESIGN

This study adopted a descriptive, phenomenological design.

METHODS

After psychiatric placement, a semi-structured interview was conducted in June 2022 among 22 final-year undergraduate nursing students using purposive sampling. The data were analysed using Colaizzi's seven-step analysis method.

RESULTS

Five themes were identified: i) destigmatising mental illness; ⅱ) beneficial communication; ⅲ) gaining confidence; iv) disappointment and sadness; and v) fear and discomfort.

CONCLUSION

Nursing students experienced various positive experiences and negative emotions during their psychiatric placement. Further research should explore and validate appropriate educational strategies to optimise students' placement experiences to increase their career interest in psychiatric nursing.

Photovoice as a Method to Reduce the Stigma of Mental Illness Among Health Care Students

Photovoice is theorized to influence those who interact with the photos and captions, and so it is important to examine and further understand this mechanism. This article seeks to further our understanding of this critical process—that is, what is the impact of the Photovoice Artist’s stories on the viewing audience? Herein we demonstrate how an incarnation of photovoice, digital storytelling, and photo elicitation impacted mental illness stigma among health sciences students. By focusing on application beyond the original exhibition, this article highlights how photovoice methods and aims overlap with best practices in stigma reduction, and its fit with multimodal anti-stigma interventions. Overall, this study contributes to addressing the question of how photovoice can be applied to achieve action for social change.

Effects of the psychiatric nursing course on students' beliefs toward mental illness and psychiatric nursing perceptions in Turkey

PURPOSE

To investigate the effects of the psychiatric nursing course on students' beliefs toward mental illness and psychiatric nursing perceptions.

DESIGN AND METHODS

This experimental study was carried out with 80 students enrolled for the psychiatric nursing course.

FINDINGS

The mean score of the Beliefs toward Mental Illness Scale decreased, and the mean score of the Psychiatric Nursing Perception Scale increased after the course. The difference between the measurements was statistically significant (p < 0.05).

PRACTICE IMPLICATIONS

This study shows that psychiatric nursing course is effective in decreasing students' negative beliefs toward mental illness and increasing positive psychiatric nursing perceptions. Students' attitudes about mental illness and psychiatric nursing should be determined from the very first year of their education, and their negative beliefs should be intervened with.

Nursing students' experience of the mental health setting as a clinical learning environment: Findings from a national study

PURPOSE

To explore nursing students' perceptions of their clinical learning experiences in the mental health (MH) setting.

DESIGN AND METHODS

Secondary analysis of data collected within an Italian national cross-sectional study involving students (N = 9607) who were attending 95 3-year baccalaureate nursing programs.

FINDINGS

Students in MH settings scored the quality of the learning environment overall significantly higher (P = .008) compared to those who rotated in other clinical settings, specifically with respect to (a) the tutorial strategies' quality; (b) the learning opportunities; and (c) the learning environment's quality.

PRACTICE IMPLICATIONS

MH settings emerged as a worthy clinical environment where less pressing rhythms allow preceptors to provide students more learning opportunities that, in turn, affect the perceived degree of competence achieved and the desire to work in these contexts after graduation.

The Spanish version of the Psychiatric/Mental health clinical placement survey and an assessment of Spanish student attitudes towards mental health

WHAT IS KNOWN ON THE SUBJECT?: The Psychiatric/Mental Health Clinical Placement Survey preplacement, validated in English and widely used, assesses nursing student attitudes towards the mental health field. There are no validated scales in Spanish to assess students' attitudes towards mental health, nor is there evidence of attitudes in Spanish students. WHAT DOES THIS ARTICLE ADD TO EXISTING KNOWLEDGE?: The present study was the first to address the validity of a scale which evaluates nursing student attitudes towards mental health issues, in Spanish. Until now, no knowledge was available on nursing student attitudes towards mental health issues in the Spanish context. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The results provide faculty professors with a validated tool to use to assess attitudinal changes in students, following theoretical and practical training in mental health. To have an up-to-date perspective on student attitudes towards both the field of mental health and people with severe mental illness, thereby providing the opportunity to focus on those aspects requiring improvement. Abstract Introduction The encouragement of positive attitudes towards mental health is necessary in order to improve the quality of healthcare assistance. The attitudes of nursing students towards mental health are unknown, and there are no validated scales for their assessment. Aims To adapt the Psychiatric/Mental Health Clinical Placement Survey (PMHCPS) to Spanish and examine its psychometric properties; to describe the attitudes of nursing students towards the mental health field. Method Confirmatory factorial analysis (CFA), internal consistency and construct validity were performed. An assessment of the students' attitudes was also conducted. Results The CFA showed appropriate fit, and total internal consistency was adequate. With regard to construct validity, knowledge was associated with practicum mark. The students achieved above mid-range scores for all subscales, except negative stereotypes. Gender differences were observed. Discussion The PMHCPS, translated to Spanish, enables the students' attitude towards the mental health field to be assessed, thus identifying those areas of student attitudes and competencies requiring improvement. Implications for practice To provide Spanish nursing faculties with access to a scale, with which to assess changes in student attitudes. The assessment results may then be utilized to formulate teaching methods in order to improve the quality of health care the students might provide as future nursing professionals.

Career interests of undergraduate nursing students: A ten-year longitudinal study

An understanding of students' career interests at entry and exit from undergraduate nursing programmes could inform decisions regarding curricula and clinical placements. Since 2006, the University of Auckland has surveyed healthcare students at entry to and exit from their respective programmes, collecting information on a range of demographic, and career-related factors. This article describes career interests of over 500 undergraduate nursing students in New Zealand over a ten-year period. All Bachelor of Nursing cohorts commencing between 2006 and 2016 were invited to complete a questionnaire which included questions about their career interests. In total 1875 questionnaires were completed (89% response rate). Among the overall cohort at entry, there was strongest interest for emergency care and child health, and least interest in older person's health. At exit, child health and surgery (general) were of strongest interest to the cohort, while older person's health remained of least interest. The analysis of the paired data (n = 564) identified decreases in interest for mental health and child health over the course of the programme, while there was an increased interest in primary health care. Changes in career interests indicate that education and clinical exposure to specialty areas during the programme may influence career interests.

Undergraduate nursing students' stigma and recovery attitudes during mental health clinical placement: A pre/post-test survey study

Undergraduate nursing students have been reported to hold negative and stigmatizing attitudes towards mental health consumers and to be under-prepared for mental health clinical placement. This study aimed to investigate undergraduate nurses' stigma and recovery attitudes to mental illness, and describe their understandings of personal recovery on entry and exit to traditional mental health clinical placement. A pre/post-test survey was administered to N = 249 nursing students in Australia. Demographic data, attitudes towards mental health nursing and clinical placement, the Opening Minds Scale for Healthcare Providers (OMS-HC), Recovery Attitudes Questionnaire (RAQ-7), and an open-ended question on understandings of personal recovery from mental illness were collected on entry (T1) and exit (T2) to placement. At T1, students reported moderate stigma and positive attitudes towards recovery (OMS-HC mean = 34.6; RAQ-7 mean = 4.0). At T2, there was a reduction in stigma (social distance P = 0.02, d = 0.26) and improvement in recovery attitudes (P < 0.01, d = 0.40). Attitudes towards mental health nursing and placement also improved (P < 0.01). Having a family member with mental illness predicted improvements in stigma and recovery attitudes. On entry to placement, most students described accurate understandings of personal recovery, which were maintained during placement. The findings indicate that mental health clinical placements are effective in improving students' mental health stigma and recovery attitudes and provide a prime opportunity to attract students into the field. Co-produced or consumer-led education provided by peer workers during clinical placements may improve students' stigmatizing attitudes and stimulate their interest to work in the field.

Educational intervention to decrease stigmatizing attitudes of undergraduate nurses towards people with mental illness

Health professionals can hold stigmatizing views about people with mental illness. In addition to being discriminatory, these beliefs cause anxiety that can affect learning in the clinical environment. A review of an undergraduate nursing curriculum introduced the Modern Apprenticeship curriculum model and provided an opportunity for an educational intervention designed to address stigmatizing beliefs about people with mental health and addiction problems. The aim of the present study was to measure the extent to which an educational intervention - guided clinical experience in an acute mental health unit during the first year of the curriculum - decreased stigmatizing beliefs of undergraduate nurses towards those with mental health and addiction issues. In a before-and-after design, Corrigan's Attribution Questionnaire was used to collect data pre- and post-guided clinical experience in an acute mental health unit. The intervention resulted in a significant positive change in stigmatizing attitudes for four of the nine factors tested. There was a non-significant positive change in three factors, while two factors showed a non-significant negative change. Using guided clinical experience as an educational intervention in the first year of an undergraduate nursing curriculum can contribute to positive change in undergraduate nurses' stigmatizing beliefs. The findings have implications for teaching of mental health content in undergraduate nursing programmes.

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.

Why is psychiatric nursing not the preferred option for nursing students: A cross-sectional study examining pre-nursing and nursing school factors

BACKGROUND

There is a shortage of nurses working in the mental health field globally. The aim of the present study was to examine Singapore nursing students' attitudes towards specializing in psychiatric nursing by examining the pre-nursing and nursing school factors as well as attitudes towards psychiatry and personality traits.

METHODS

A cross-sectional online survey was conducted with 500 nursing students from four nursing institutions in Singapore. Students' attitudes towards psychiatry (ATP-18), perception of psychiatric nursing career aspects relative to other fields, and personality traits (mini-IPIP) were assessed. The main outcome measure was likelihood of specializing in psychiatric nursing. Logistic regression was used to examine the combined effect of factors upon the outcome.

RESULTS

Twenty-six students (5.2%) rated "definitely decided to do" psychiatric nursing. Pre-nursing school factors associated with choosing psychiatry included ethnicity, current education, parents' wishes, having personal/family experience of mental illness, prior work experience, interest in psychiatric nursing and psychology module taken prior to current school admission. Nursing school factors such as teaching methods and clinical exposure were not associated with choosing psychiatric nursing. Positive attitudes towards psychiatry, perception of better career aspects in psychiatric nursing relative to other fields, and the personality traits of extraversion and intellect/imagination were associated with likelihood of choosing psychiatric nursing. Logistic regression revealed Malay (OR: 1.90, 1.14-3.16, p=0.013) and Indian ethnicity (OR: 2.56, 1.32-4.96, p=0.005), interest in psychiatry (OR: 22.56, 8.22-61.92, p<0.001), psychology module prior to current school admission (OR: 2.31, 1.28-4.17, p=0.005), better perceived job prospects in psychiatric nursing than other fields (OR: 1.91, 1.21-3.04, p=0.006), extraversion (OR: 1.09, 1.02-1.17, p=0.012) and positive attitude towards psychiatry (OR: 2.72, 1.75-4.23, p<0.001) as factors associated with students choosing psychiatric nursing.

CONCLUSIONS

The selection of psychiatry as a specialty by nursing students was affected by pre-nursing school factors. Taking these factors into consideration may improve recruitment and alleviate the shortages in the psychiatric nursing field.

"They're Really PD Today"

The therapeutic relationship is of particular importance when working with patients with antisocial personality disorder, but despite this, there is a paucity of literature exploring student nurses' perceptions of developing a therapeutic relationship with such patients. Hence, this qualitative study explored the perceptions of second-year mental health nursing students of developing a therapeutic relationship with this patient group. Student nurses from a University in the Northwest of England participated in two focus groups, to compare the perceptions of a group of student nurses who had experience in secure settings (forensic hospital) with those who had not. Four key themes emerged: diagnosis, safety, engagement, and finally environmental influences. Both groups commented on looking beyond the diagnosis and seeing the person. The student nurses cited other staff in their clinical placement areas as hugely influential in terms of the development of their perceptions of patients with antisocial personality disorder and how to relate to them.

Comparing Mental Illness Stigma among Nurses in Psychiatric and Non-Psychiatric Wards in Tabriz University of Medical Sciences

Stigma can complicate people’s mental health problems by affecting different sides of personal life, increasing negative attitudes, causing discriminatory behavior towards them, and reducing the chances of recovery and returning to normal life. This research aims to compare the stigma of mental illness among nurses working in psychiatric and non-psychiatric wards in Tabriz University of Medical Sciences. A total of 240 nurses participated in this descriptive and analytic study. The data were collected using a demographic questionnaire and the Community Attitudes towards the Mentally Ill (CAMI) Scale, which is a 40-item self-report questionnaire. All data were analyzed using SPSS 13. The majority of nurses have a medium level of stigma toward people with mental illness, and there is no significant relation between the type of wards and mean stigma scores. After eliminating factors such as mental illness in nurses and their families, it seems that only working with people with mental illness in psychiatric wards is not enough to create a positive attitude toward them. Additionally, the less physical activity and taking advantage of legal benefits of work hardship for psychiatric nurses, low income, and stigma toward psychiatric nursing, probably may make a difference in inclining to work in psychiatry ward between the two groups in spite of relatively equal stigma scores.

The Nursing Students' Experience of Psychiatric Practice in South Korea

In 1995, South Korea passed the Mental Health Act, and since this time it has developed many mental health policies and facilities. The aim of this study is to understand and explore the experience of nursing students in the changed psychiatric practice environment since 1995. The present study is a qualitative thematic analysis. Interviews were conducted with 11 third and fourth grade nursing students who had experienced psychiatric practice in South Korea. A thematic analysis of 11 in-depth student interviews identified three themes: 'orientation before psychiatric practice', 'facing the mental hospital', and 'change and choice'. After practicing, nursing students developed positive attitude regarding psychiatry. Educators will have to focus more on education and support in order for the students to maintain positive attitude throughout their experience. The research herein shows that the role of the educators and psychiatric nurses is extremely important for nursing students in the elimination of a negative attitude towards psychiatry.

A better way to do this? Views of mental health nursing directors about preparation for mental health nursing practice

OBJECTIVE

Nursing directors in mental health services hold important leadership positions that include responsibility for the nursing workforce. The comprehensive or generalist approach to undergraduate nursing education consistently poses significant recruitment problems. Specialisation in mental health within Bachelor of Nursing programs has been suggested as a potential solution. This paper presents the views and opinions of mental health nursing directors regarding undergraduate specialisation.

METHODS

A qualitative exploratory study was undertaken. Thirteen nursing directors from Queensland Mental Health Services participated in an in-depth telephone interview. The data were analysed thematically.

RESULTS

Nursing directors were very supportive of specialisation in mental health at the undergraduate level. Thematic analysis revealed four main themes: perceived advantages of the specialist stream; knowledge and experience; increased recruitment; and commitment.

CONCLUSIONS

Nursing directors are important stakeholders in educational preparation for practice in mental health settings. The research participants described many potential benefits to undergraduate specialisation. Their voice provides an important contribution to this issue.

Career Choice and Longevity in U.S. Psychiatric-Mental Health Nurses

The demand for mental health services in the United States taxes the existing care continuum and is projected to increase as federal initiatives such as the Affordable Care Act and mental health parity improve access to, and coverage for, mental health services. Quality health care providers, such as psychiatric-mental health nurses, are needed to bolster the mental health system. Prior research has focused on the unpopularity of psychiatric nursing as a career choice for nursing students. The purpose of this study is to understand how seasoned psychiatric nurses came to choose and remain in the specialty; descriptive phenomenology is used. In a face-to-face interview, eight registered nurses described their experiences with psychiatric nursing as a student, their entry into psychiatric nursing, and factors related to their longevity in the specialty. Giorgi's Existential Phenomenological Research Method was employed to analyze the interview data. Three themes emerged related to career choice: Interest Developed Prior to or While in Nursing School, Personal Relevance, and Validation of Potential. Three themes emerged related to retention: Overcoming Stereotypes to Develop Career Pride, Positive Team Dynamics, and Remaining Hopeful. Nurse educators play an important role in identifying talent, validating capability, enhancing interest, and increasing students' confidence to pursue a psychiatric nursing career, while nursing administrators and clinical specialists play a key role in retention. Findings also stimulate pertinent questions surrounding the long-term viability of the psychiatric-mental health nursing specialty.

Preceptors' Expectations of Nursing Students' Preparation before Placement in Psychiatry: Ability and Will to Reflect on and Exercise Knowledge

Nursing students must be prepared to provide nursing care regardless of the patient's illness. This requires that nursing education, including clinical placements, strengthen knowledge and skills in mental health nursing. The aim of this qualitative study was to describe 15 preceptors' expectations of nursing students' preparedness before they entered the psychiatric field. Data was collected with focus group interviews and analysed using conventional content analysis. The findings show that preceptors are concerned about the nursing students' will and ability to reflect on and exercise knowledge for managing the student role and themselves; for adapting their perspective on humanity; for their understanding of illness and how they are interacting with persons with mental illness. The conclusion is that the preceptors expect the educators to give sufficient theoretical knowledge and assess the students' personal maturity prior to entering the psychiatric field.

Psychiatric nursing: an unpopular choice

Research studies in the United States, the United Kingdom, New Zealand and Australia suggest that students do not consider psychiatric nursing as a popular career option. According to this research, there is a widespread concern about the nursing shortages in psychiatry. The demand for mental health services continues to grow and there is a need for strategies to recruit nurses for this specialized field. The purpose of this study was to identify the factors preventing undergraduate nursing students in South Africa (SA) from choosing psychiatric nursing as a career. A qualitative research design that aimed to explore and describe was used. Data were collected through the Nominal Group Technique. A sample of convenience of 27 final year nursing students from the School of Nursing at the University of the Free State as well as the Free State School of Nursing, situated in Bloemfontein (SA), voluntarily participated in this research. The following categories emerged from the content analysis of the data: personal factors, working environment, unprofessional behaviour, learning environment and the unclassified category. Psychiatric nursing as a career choice is in a predicament and nursing schools need to implement practical strategies to recruit future nurses for this field.

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.

A major stream in mental health in undergraduate nursing programmes: identifying the benefits and acknowledging the innovation

The literature demonstrates the problems mental health nursing has faced in securing sufficient graduate nurses to meet current and projected workforce needs. Deficiencies in educational preparation have been identified as a significant contributing factor. A major stream in mental health nursing has been introduced into undergraduate Bachelor of Nursing programmes as one strategy to address this problem. To-date, 11 streams have been introduced into Australian universities and no evaluations of the impact of these initiatives have been published as yet. This qualitative research was undertaken to explore the implementation and outcomes of major streams. In-depth telephone interviews were undertaken with participants from 10 universities, to explore their experiences with and opinions of this initiative. This paper specifically addresses the perceived benefits. Qualitative data analysis revealed many benefits to the major in promoting the value of, and encouraging interest in mental health nursing for undergraduate students. Four main themes were identified: (1) benefits to students; (2) benefits to the university; (3) benefits to industry; and (4) innovative approaches to education. The findings suggest the major in mental health nursing can contribute to addressing workforce problems in mental health nursing.

Back to the future? Views of heads of schools of nursing about undergraduate specialization in mental health nursing

Preparation of nursing students for practice in mental health settings in Australia has been criticized since comprehensive education replaced preregistration specialist education. Current and projected workforce shortages have given rise to considering the reintroduction of specialization at preregistration level as a potential solution. Support of heads of schools of nursing would be essential for such an initiative to be considered. A qualitative exploratory study was undertaken involving in-depth telephone interviews with heads of schools of nursing in Queensland. Participants generally favoured the concept of specialization in mental health nursing at undergraduate level. Data analysis revealed the following themes: meeting workforce needs, improving quality of care, employability of graduates, an attractive option for students, and what would have to go. Participants identified many benefits to mental health service delivery and consumer outcomes. How the initiative could be developed within an already overcrowded curriculum was identified as the major barrier. This level of support is encouraging if necessary changes to the educational preparation for mental health nursing practice are to be considered.

Perspectives of Australian nursing directors regarding educational preparation for mental health nursing practice

There is an ongoing global shortage of mental health nurses. Within Australia, the principal strategy of offering a postgraduate education programme with various incentives to encourage nurses back to study has not been successful. This has led to the consideration of radical alternatives, including the return to pre-registration specialisation in mental health. The successful introduction of this strategy would require the full support of industry partners. To date, the voice of industry has not been heard in relation to this issue. The aim of this paper is to present the views of an Australian sample of mental health nursing directors regarding the resources and other factors required, should undergraduate specialist programmes in mental health be developed, to ensure they are relevant and likely to be successful. A qualitative exploratory research project was undertaken to explore the perspectives and opinions of industry partners. In-depth interviews were conducted with nursing directors (n = 12) in Queensland Australia. Five main themes were identified: relationships with universities; clinical placement preparation and support; workplace culture; facilitators and preceptors; and practical student learning. Genuine collaboration between the two organisations was considered crucial for delivering a quality programme and providing the required support for students. Transformative leadership could inform this collaboration by promoting acknowledgement of and respect for differences.

Lived-experience participation in nurse education: reducing stigma and enhancing popularity

Mental health nursing consistently emerges as less popular than other specialties, and both service users and mental health practitioners are affected by negative attitudes. Education is fundamental to attracting students to the field of mental health nursing. The aim of this study was to determine the impact of undergraduate mental health curricula on student attitudes to people with mental illness, and career interest in mental health nursing. A traditional mental health course was compared to a course delivered by a person with lived experience of mental illness (and mental health service use) for its impact on student attitudes and career intentions in mental health nursing (cohort 1: n = 70, cohort 2: n = 131, respectively). In both cohorts, attitudes were measured via self-report, before and after the course, and changes were investigated through within-subjects t-tests. The lived experience-led course demonstrated statistically-significant positive changes in intentions to pursue mental health nursing and a decrease in negative stereotypes, which were not observed in the traditional course. The valuable contribution of mental health nursing emerged in the traditional, but not lived-experience-led, programmes. These findings support the value of an academic with lived experience of mental health challenges in promoting attraction to mental health nursing as a career option.

Implementing a major stream in mental health nursing: barriers to effectiveness

Changes to the educational preparation of the nursing workforce in mental health continue to have profound effects on the availability of sufficient numbers of skilled graduates willing to work in this field. The longevity of the problem has focused attention on possible solutions. Introducing a major stream in mental health nursing in undergraduate Bachelor of Nursing programmes was proposed and supported as a potentially beneficial strategy, adopted by some Australian universities. Despite the promise invested in this strategy, systematic evaluations to determine the effectiveness or otherwise of this approach were not initiated. A qualitative exploratory study was undertaken with Australian universities, which had implemented the major stream, regarding their experiences and observed outcomes. In-depth interviews were conducted with a mental health nurse academic from each university. The barriers to the effectiveness of the major in mental health nursing are the specific focus of this paper. Thematic data analysis revealed three main barriers: clinical placements, lack of support from other academics, and integrated curricula. These barriers substantially limited the effectiveness of this strategy - in some instances, leading to the programme's termination - and must be assertively addressed to maximize the potential of the major in mental health nursing.

Changing nursing student attitudes to consumer participation in mental health services: a survey study of traditional and lived experience-led education

Mental health policy emphasises the importance of consumer participation in mental health services. To align education with policy and orient future healthcare services to active consumer involvement, the potential of academics with a lived experience of mental illness to impact on student attitudes towards consumer participation needs to be examined. A cohort comparative study was undertaken comparing attitudinal change between undergraduate nursing students undertaking two different mental health courses, one nurse-led (n  =  61) and one lived experience-led. Attitudes were measured through the Mental Health Consumer Participation Questionnaire. Within-cohort change was assessed via dependent sample t-tests, and degree of change was observed in each cohort, by comparing effect sizes. For the nurse-led course, attitudes on consumer involvement t (60)  =  -1.79, p < 0.005 (95% CI: -2.84, -0.74) and consumer as staff t (60)  =  -4.12, p < 0.005 (95% CI: -3.34, -1.16), positively changed with effect size r of 0.40 and 0.47, respectively. For the lived experience-led course, attitudes on consumer capacity t (109)  =  -3.63, p < 0.005 (95% CI: -0.48, -1.41) and consumer as staff, t (109)  =  -5.63, p < 0.005 (95% CI: -0.97, -0.46), positively changed, effect size r of 0.33 and 0.47, respectively. Mental health nursing education has a positive and selective influence on attitudes to consumer participation. Lived experience-led education was more beneficial in changing attitudes to consumer capacity and both types of education had similar positive effects on attitudes to consumers as staff.

Perceived stress and coping strategies among Jordanian nursing students during clinical practice in psychiatric/mental health courses

Clinical practice in the psychiatric/mental health nursing (PMHN) field is considered a highly-stressful experience for nursing students. The purpose of the present study was to identify the degrees of stress, the types of stressors, and coping strategies perceived by undergraduate nursing students during their clinical practice in PMHN courses. A descriptive, longitudinal design was used. Sixty-five students registered in PMHN clinical courses were recruited from five Jordanian universities using a systematic random-sampling method. Data collection was conducted in the second semester of the 2012-2013 academic year at two points of time: pre-PMHN clinical training and post-PMHN training. The Basic Information Questionnaire, Perceived Stress Scale, and Coping Behavior Inventory were administered. Students' ages ranged from 20 to 25 years. The findings illustrate that the highest reported types of stressors at both data-collection times were taking care of patients, stress related to teachers and nursing staff, and from assignments and workloads. The most utilized coping strategy at both data-collection times was problem solving. The findings of the present study are useful for clinical educators in identifying nursing students' stressors, easing their learning in the clinical setting, and establishing an efficient PMHN course programme.

No place to turn: nursing students' experiences of moral distress in mental health settings

While researchers have documented the significant issue of moral distress among nurses, few have explored moral distress among mental health nurses. In addition, no research to date has explored nursing students' experiences of moral distress during mental health clinical rotations, despite nursing students typically reporting negative attitudes towards mental health nursing. This manuscript reports on a qualitative study involving seven Canadian baccalaureate nursing students, who reported on their experiences of moral distress during a 13-week clinical rotation on inpatient psychiatric units. Overall, nursing students reported significant moral distress related to the perceived lack of nurses talking meaningfully to patients on the unit, a hierarchical power structure for physicians, a lack of information given to patients about their psychiatric medications, and an inability of their nursing instructors to advocate for ethical change on the units. Several students made a specific connection between their moral distress and not wanting to pursue a career in mental health nursing.

Opportunity lost? The major in mental health nursing in Australia

BACKGROUND

The ongoing difficulty in educating and sustaining an adequate nursing workforce in mental health settings has been identified throughout the world. Different strategies have been implemented internationally to deal with this situation. In Australia major streams in mental health nursing were introduced in some Australian universities to promote mental health nursing as a viable career choice for nursing students. Fourteen universities had implemented or planned to implement a major stream in mental health nursing. From a survey of these programs a lack of consistency in the structure and content of programs was evident. For most programs the intakes had been relatively small, although retention rates appeared promising.

OBJECTIVES

To determine the extent majors in mental health nursing introduced in Australia have been sustained since their implementation.

DESIGN

Cross-sectional design. A survey instrument used in 2010 was readministered in 2013.

SETTING

Schools of Nursing in Australia where a major in mental health nursing had been implemented or planned.

PARTICIPANTS

Subject and program coordinators.

METHODS

The survey was administered via email.

RESULTS

Of the 14 majors in mental health nursing originally proposed or implemented, only five were remaining, three had never commenced the program despite plans to do so and six programs once operating had now ceased. Numbers of students undertaking the program have tended to be small. Few modification changes in the structure and content in the majors since initial implementation were reported.

CONCLUSIONS

The findings suggest that the major in mental health nursing has not been a successful or sustainable strategy, and therefore is unlikely to contribute positively to strengthening the mental health nursing workforce. The availability of sufficient graduate nurses with the interest and skills to pursue a career in mental health nursing is becoming urgent. The adequate resourcing of strategies to address this issue needs to be considered as a matter of priority.

The views of heads of schools of nursing about mental health nursing content in undergraduate programs

Criticisms about the mental health nursing content of Bachelor of Nursing programs have been common since the introduction of comprehensive nursing education in Australia. Most criticism has come from the mental health nursing sector and the views of key stakeholders have not been systematically reported. Heads of Schools of Nursing have considerable influence over the content of nursing programs, and their perspectives must be part of ongoing discussions about the educational preparation of nurses. This article reports the findings of a qualitative exploratory study, involving in-depth interviews with Heads of Schools of Nursing from Queensland, Australia. Thematic data analysis revealed two main themes: Realising the Goal? and Influencing Factors. Overall, participants did not believe current programs were preparing graduates for beginning level practice in mental health settings. In particular, participants believed that the quality of mental health content was influenced by the overcrowded curriculum, the availability of quality clinical placements, the strength of the mental health team, and the degree of consumer focus. The findings suggest the current model of nursing education in Australia does not provide an adequate foundation for mental health nursing practice and alternative approaches should be pursued as a matter of urgency.

Learning essentials: what graduates of mental health nursing programmes need to know from an industry perspective

AIMS AND OBJECTIVES

To explore the perspectives of nursing directors in mental health in Queensland, Australia, regarding the skills and attributes of graduates of comprehensive nursing programme to provide an industry perspective and thus augment knowledge from theoretical and professional dimensions.

BACKGROUND

There is a worldwide shortage of appropriately qualified nurses with the knowledge, skills and attitudes to work effectively in mental health services. Within Australia, this has been well documented since the introduction of comprehensive nursing education. The underrepresentation of mental health content in undergraduate curricula has been identified as the primary reason for nursing graduates not being adequately prepared for practice in this field. To date, this issue has primarily been addressed from the perspective of university academics, with the voice of industry relatively silent in the published literature.

DESIGN

Qualitative exploratory.

METHOD

In-depth telephone interviews with Director of Nursing (Mental Health) in Queensland, Australia.

RESULTS

The concerns of participants were expressed in six main themes: (1) foundational knowledge of mental health and disorders, (2) recovery-oriented skills, (3) physical as well as mental health skills, (4) therapeutic strategies, (5) resilience and self-development and (6) advanced knowledge and skills.

CONCLUSIONS

The education of comprehensive nursing education needs to be reviewed as a matter of priority to ensure graduates with the attributes required to provide high-quality care for consumers of mental health services.

RELEVANCE TO CLINICAL PRACTICE

A skilled and knowledgeable workforce is an essential component of high-quality mental health services. Research highlighting the current deficits and issues is therefore of the highest priority.

It's the anxiety: facilitators and inhibitors to nursing students' career interests in mental health nursing

Increasing the rate of recruitment of nursing students into mental health nursing (MHN) is vital to long-term sustainability of health care system support for people diagnosed with mental illness. However MHN is not a popular career path; this raises questions about what attitudes and beliefs may divert or attract students to this specialisation. The current research involved a survey of undergraduate nursing students at a regional university in Australia to clarify the nature of relationships between attitudes (e.g., the value of mental health nursing, stereotypes of people with mental illness) and how they may be antecedents to considering MHN as a career path. Through a structural equation model, it was ascertained that anxiety surrounding mental illness leads to less interest in MHN as a future career and suggests that anxiety is (a) partly due to negative stereotypes, and (b) countered by preparedness for a MHN role. Beliefs on how MHN can make a valuable contribution to people's well-being did not affect interest in pursuing MHN. These findings reconfirm the need to reduce anxiety about mental illness by educational approaches that effectively prepare students for MHN, combined with challenging negative stereotypes.

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

Mental health nursing is not regarded favourably by most Bachelor of Nursing (BN) students as a desirable career option. However, little is known about what attracts those students who do become interested. The primary aim of the current study was to explore BN students' reasons for choosing to undertake the major in mental health nursing and the degree to which completing the subject: "Recovery for mental health nursing practice", confirmed that interest or otherwise. A secondary aim was to examine their perceptions about the attitudes of others to their expressed interest in mental health nursing. A qualitative exploratory study was undertaken with undergraduate nursing students (BN) (n = 12) enrolled in a major stream in mental health nursing. In-depth individual interviews were conducted primarily by telephone. Data were analysed using Colaizzi's steps to explicate the main themes. Two main themes emerged: Swimming against the tide - that's not real nursing, captures participants' experience of the negative attitudes of others to their interest in mental health nursing; and, creating and confirming an interest in mental health nursing, where participants discuss how their interest emerged and how it had been enhanced after completing the subject: Recovery for Mental Health Nursing Practice. Mental health nursing continues to be a stigmatised and undervalued profession both within nursing and the general public. Despite this, participants of this research were attracted to the specialty, and their interest was generally strengthened after completing the Recovery subject. Further research is required to examine the impact of being taught by an academic with lived experience on interest in mental health nursing as a career.

A comparative study of attitudes toward psychiatry among nursing students across successive training years

CONTEXT

Psychiatry nurses are an integral component of a multidisciplinary mental health-care team.

AIM

The current study aimed at understanding the attitude of undergraduate nursing students toward psychiatry. Additionally, the attitudes toward psychiatry have been compared across the training years among these students.

MATERIALS AND METHODS

The study was carried out at a tertiary care nurse-training institute. All the nursing students enrolled with the institute at the time of the study constituted the sample frame. The study questionnaire used in the current study was a 29-item questionnaire that assessed attitudes toward psychiatry.

STATISTICAL ANALYSIS

The data were analyzed using SPSS ver 17.

RESULTS

Overall, the majority of the nursing students from all four groups had a favorable response to the statements of the Likert scale. Most of the significantly positive responses (as assessed by the Kruskal-Wallis analysis of variance of the rank order) were from the third-year and internship students. These findings were supported by the significant correlation between these statements and ranked order of the nurse-training years.

CONCLUSIONS

The findings of the current study present some interesting insights into the attitude of nursing students toward psychiatry.

Reflecting on holistic nursing: the contribution of an academic with lived experience of mental health service use

The educational preparation of registered nurses is presumed to reflect a holistic approach with emphasis on the bio-psycho-social model of care. The broader literature suggests this goal is not always realised. The aim of this study is to present the views, experiences, and perceptions of undergraduate nursing students who were taught by an academic with a lived experience of mental health service use. In particular, we wanted to look at the expected impact of this approach to learning on their nursing practice. A qualitative, exploratory approach was used, involving in-depth individual interviews with 12 undergraduate nursing students completing the course, "recovery for mental health nursing practice," as part of a major in mental health nursing in a university in Queensland, Australia. Students were asked to reflect upon and discuss their experiences of being taught by a person with lived experience of mental health service use. Data were analysed following Colaizzi's steps to identify the main themes. The three main themes were (1) recovery--bringing holistic nursing to life; (2) influencing practice; and (3) gaining self-awareness through course assessment: challenge and opportunity. These themes suggest an appreciation for holistic nursing and an increased capacity for reflective understanding. The responses from participants suggest the Recovery course had a significant impact on their attitudes to nursing and that their nursing practice would be positively enhanced as a consequence.

Student nurses' perceptions of mental health care: validation of a questionnaire

AIM

This article describes the results of a study into the psychometric properties of a questionnaire about student nurses' perceptions of mental health care. The questionnaire was constructed in 2008, but has not yet been tested in terms of construct validity and reliability. A validated questionnaire is essential as a standardized method of analyzing student nurses' perceptions of mental health care.

METHOD

To investigate the construct validity, an exploratory factor analysis was performed. Reliability was determined by measuring the internal consistency of the questionnaire.

RESULTS

A principal component analysis (PCA) yielded a two-factor solution. The first factor comprised 9 items referring to the views of student nurses on psychiatric patients; the second factor comprised 6 items referring to the views of the students about professional careers in mental health care.

CONCLUSION

The factor analysis and questionnaire produced two easily interpretable factors covering the same categories as those identified in the literature as determinants of a student nurse's choice for or against a career in mental health care. The questionnaire's construct validity was rated as sufficient, its reliability as acceptable. The problem is the low explained variance (25.6%). The usefulness of the questionnaire is therefore questionable. The usefulness might be improved through the expansion of some of the categories by additional items. Relevant suggestions are made in this article.

Promoting mental health nursing: employing undergraduate nursing students as assistants in mental health

The difficulty in attracting graduates of nursing programmes into mental health nursing (MHN) remains an ongoing challenge. Moreover, it is frequently claimed that undergraduate nursing students do not always regard MHN favourably for future employment. Although undergraduate nurses are employed as assistants in nursing (AIN) in mental health settings, there is no published research exploring their role, the career trajectory into MHN, or its effectiveness as a recruitment strategy. In this paper, we draw on the literature to delineate factors that might contribute to the desire of AIN to work in MHN. Nine factors were identified: acceptance by nurses, fitting in with the culture, managing the workload, developing a realistic appraisal of the effectiveness and limits of psychiatry, constructive learning from direct interpersonal interactions with clients, practising communication skills, being supported in a structured way, working with positive role models, and the overall quality of the employment setting. A comprehensive understanding of these factors can enhance the experience of undergraduate nursing students working as AIN, and potentially increase recruitment into MHN.

Effects of psychiatric training on nursing students' attitudes towards people with mental illness in Japan

BACKGROUND

Nursing students' attitudes towards people with mental illness can be influenced by training experience.

AIM

To examine the relationship between the attitudes of nursing students towards people with mental illness and the psychiatric training imparted to the students by using textual data and conducting frequency analysis.

METHODS

We identified the words/phrases which were considered to represent the attitudes towards people with mental illness at pre-training (T1) and post-training (T2) stages from reports written by 76 Japanese nursing students, and examined the differences in the frequencies of the words/phrases used at T1 and T2.

RESULTS

With regard to the students' attitudes towards people with mental illness, generally, the frequencies of words/phrases that had somewhat negative to strongly negative nuances were high at T1, whereas those of the words/phrases that had somewhat positive or neutral nuances were high at T2. Also, analysis showed that words/phrases such as 'scary' were used more frequently at T1, whereas words/phrases such as 'not scary' were used more often at T2.

CONCLUSION

The students' attitudes may change favourably owing to, at least in part, psychiatric training.

Placing physical activity in mental health care: a leadership role for mental health nurses

The wide-ranging benefits of physical activity for consumers with mental illness are acknowledged within the mental health nursing field; however, this is not commonly translated to practice. The primary aim of this paper is to argue that mental health nurses are well positioned to, and should, provide leadership in promoting physical activity to improve the quality of care for people with mental illness. Topics addressed in this paper include the relationship between physical activity and both physical and mental health, the views and experiences of consumers with physical activity, the efficacy of physical activity interventions, the attitudes of nurses to physical activity as a component of care, barriers to a physical activity focus in care for mental illness, and the role of mental health nurses in promoting physical activity. There is a clear and important relationship between physical activity and mental health. Mental health nurses are well positioned to encourage and assist consumers to engage in physical activity, although they might lack the educational preparation to perform this role effectively.

Implementation of a major in mental health nursing in Australian universities

The difficulty recruiting and retaining an adequate mental health nursing workforce is acknowledged. The major in mental health nursing has been identified as a strategy to promote this specialist area of practice as desirable for students' future careers. Measuring its success requires the collection of detailed data about the structure, content, and uptake of these programmes. A survey was specifically developed to elicit descriptive information about the structure and content of a major in mental health nursing programmes. Fourteen universities participated in this research. Eight had implemented a major, one intends to do so in 2011, and five had abandoned or suspended their plans for the major. The findings suggest considerable variation in both structure and content of the major in mental health nursing throughout Australia. Students are required to commit to and commence the programme at differing stages, and there is a substantial variation in the theoretical and clinical content in mental health undertaken as a requirement for the major. The numbers of students taking the major is relatively small in most universities; however, the retention rates are favourable. These findings provide important data for discussion about the ideal structure and content of a major in mental health nursing.

Mental health content of comprehensive pre-registration nursing curricula in Australia

In 2008 the final report of the Mental Health Nurse Education Taskforce was released. This paper presents the findings of the report’s survey into the mental health content of generic pre-registration nursing curricula in Australia. A questionnaire was sent to all nursing schools providing pre-registration curricula. Results indicate curricula contained a wide range of mental health theory and clinical hours. While the majority of universities incorporated most of the 20 key topics recommended by the Mental Health Nurse Education Taskforce in their courses, few addressed issues such as Indigenous mental health. There was considerable competition for placements between universities, and concern about the quality of some placements. Nurse academics with formal qualifications in mental health and specialist clinical mental health nurses were mainly involved in teaching theory. Specialist mental health clinicians and clinical educators were the key groups engaged in students’ clinical education, and preceptorship was the most common form of clinical supervision. Consumers and carers had limited involvement in the development or provision of mental health content of pre-registration curricula. Greater attention is needed to increasing the mental health content in pre-registration curricula. Furthermore, initiatives should be developed to increase access to clinical placements and reduce competition for places between universities.

The first experiences of clinical practice of psychiatric nursing students in Taiwan: a phenomenological study

AIMS AND OBJECTIVES

The purpose of this study is to understand the experiences of psychiatric nursing students during their first encounters with psychiatric patients in a clinical setting. The objective is to assist educational professionals in mental health to improve teaching strategies.

BACKGROUND

In clinical settings, student psychiatric nurses have to face complex problems and situations that can result in distress. Sometimes the student nurse will be uncertain of their own ability and this is reflected in a sense of fear on the part of some nurses. However, little research has been conducted into the first clinical experiences of such nursing students in Taiwan.

DESIGN

A qualitative phenomenological study was devised to explore what psychiatric nursing students perceived during their first experiences of clinical practice and narratives were analysed using Colaizzi's seven-step method.

METHOD

A phenomenological approach and purposive sampling were used in the study. Face-to-face interviews were conducted to collect the data and during the process of data analysis we established epochs (bracketing) and focused on the reality of the student nurses' experience to keep the data objective.

RESULTS

Four themes were identified: breaking the stigma of mental illness, developing a trusting relationship with the patient, gaining professional knowledge and skills and the process of student growth.

CONCLUSION

The findings from this study demonstrate that it is important to understand the perceptions of students during their first experiences of psychiatric nursing in a clinical setting and highlight the importance of educational programs.

RELEVANCE TO CLINICAL PRACTICE

By understanding the emotional process that psychiatric nursing students may go through during their clinical practice, educators can be better able to design suitable training courses in the future.

Mental health literacy of Australian Bachelor of Nursing students: a longitudinal study

Many students have poor mental health literacy when they finish Bachelor of Nursing courses. This paper presents the findings of a longitudinal study of Australian Bachelor of Nursing students' mental health literacy about the effectiveness of interventions for people with schizophrenia. The 'Attitudes and Beliefs about Mental Health Problems: Professional and Public Views' questionnaire was used with a non-probability sample of nursing students. A time series approach to data collection was used, with data collected on three occasions between 2005 and 2007. Ethics approval was obtained from a university ethics committee. Data were analysed using SPSS Version 15.0. The students' views about the helpfulness of interventions showed a significant and positive improvement as they progressed through the course. There were significant differences over time in their views about the helpfulness of professional and lay interventions, their opinions about the helpfulness of mental health and other medications, and the usefulness of activity and non-pharmacological interventions. Because nursing students need to be mental health literate when they complete their course, mental health nursing content should be incorporated earlier in comprehensive undergraduate curricula and incrementally increased in each year of study.

Bachelor of Nursing students' beliefs about prognosis and outcomes for people with schizophrenia: a longitudinal study

Many nursing students have unfavourable attitudes towards people with mental illness. This study aimed to examine if Australian Bachelor of Nursing students' beliefs about prognosis and long-term outcomes for people with schizophrenia changed through their course. The Attitudes and Beliefs about Mental Health Problems: Professional and Public Views questionnaire, which included a vignette about a person with schizophrenia, was used with a convenience sample of students. An interrupted time series approach to data collection was used, with data collected three times between 2005 and 2007. A university ethics committee approved the study. Data were analysed using SPSS version 15. Overall, the students recognized the person's need for professional help. By third year, students were more pessimistic about prognosis if the person did not receive professional help than in their earlier years of study. By third year, students also rated the long-term outcome to be 'creative or artistic' more favourably than in earlier years. The findings showed no significant differences in perceived overall negative and positive long-term outcomes across the three data collection points. The findings reinforce the need for theoretical and clinical education in mental health to be included and progressively increased in all years of study if attitudes are to be improved.