Fear and learning in mental health settings

Student nurses' experiences of workplace violence: A mixed methods systematic review and meta-analysis

OBJECTIVES

To identify the prevalence of student-directed violence on clinical placement and description of their related experience during clinical placements.

DESIGN

Mixed methods systematic review and meta-analysis conducted following Joanna Briggs Institute guidelines and reported according to Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

CINAHL, Embase, Medline, Proquest, PsycINFO and Google Scholar.

REVIEW METHODS

Included studies were peer reviewed, published primary studies where pre-registration nursing students were surveyed about their experiences of physical, verbal, or sexual aggression, bullying or racism during clinical placement. Studies were quality assessed but not excluded based on the result. A convergent segregated approach to synthesis and integration was undertaken. Prevalence data were extracted and pooled using both random and quality effects models; separate analyses were conducted by violence type, source, and region. Qualitative data were thematically analysed.

RESULTS

14,894 student nurses from 42 studies were included across the meta-analyses. There was substantial heterogeneity in the included data. Pooled prevalence rates ranged from racism 12.2 % to bullying 58.2 %. Bullying (38.8 %) and physical aggression (10.2 %) were most perpetrated by nurses whereas sexual aggression was perpetrated mostly by patients (64.2 %) and physicians (18.6 %). Qualitative findings identified students' descriptions of reasons for, effects of, strategies for dealing with and higher education establishments' responsibilities with regards to workplace violence.

CONCLUSIONS

Student nurses commonly experience violence during their clinical placements. Given the potential debilitating physical and psychological sequelae of all forms of violence then this study further emphasises the need to use multiple strategies to prevent violence and to better equip student nurses to manage potentially violent incidents, their responses to violence, and to whistle blow or report when they are subject to violence.

What Do Nursing Students Tell Us About Their Communication With People With Mental Illness? A Qualitative Study

BACKGROUND

Communication with individuals with mental disorder (IMDs) may often be a nonlinear, complex, and variable situation. In general, the first contact of nurses with IMDs occurs during training rotations at a psychiatric clinic. Psychiatric nursing students' initial communication experiences with IMDs may be critical to their thinking of psychiatric nursing as a career.

AIM

To determine the communication experiences of psychiatric nursing students with IMDs.

METHOD

A qualitative interview study was conducted with psychiatric nursing students studying at a nursing faculty in the east of Turkey in 2019 who completed the clinical practice. Semistructured interviews were conducted by an independent researcher. The data were analyzed using content analysis with an inductive approach.

RESULTS

In this study, maximum effort was made for data saturation criteria, and data saturation was achieved with 26 students. As a result of the data analysis, four main themes and 11 categories were developed. The main themes were as follows: (1) restrictions caused by psychological barriers, (2) restrictions caused by thinking and perceptions, (3) restrictions caused by personal and behavioral barriers, and (4) effective communication and therapeutic environment.

CONCLUSIONS

In this study, although it is seen that nursing students encounter many communication barriers with IMDs, it is an important development that they implement approaches to provide effective therapeutic communication. The results show the importance of effective nurse-patient communication skills as the first step in improving the clinical practice of nurses in psychiatry clinics.

Acceptability and efficacy of a communication skills training for nursing students: Building empathy and discussing complex situations

Nurses must demonstrate effective communication across complex interpersonal domains, as emphasized by numerous professional healthcare organizations. However, formal communication skills training has been only modestly integrated into baccalaureate nursing programs, and of those studied systematically, there are notable methodological concerns. The current study focused on application of a well-researched communication program (Comskil) to student nurses completing summer internships at a comprehensive cancer center as part of their clinical education. The Comskil training program for student nurses is an in-person, day-long training that includes three sections: responding empathically to patients; discussing death, dying, and end-of-life goals of care; and responding to challenging family interactions. Student nurse participants provided strongly favorable perceptions of the program, with 90% indicating that they agreed or strongly agreed with all perception items. A significant pre-to post-training improvement in self-reported confidence was observed (p < .01). Additionally, pre- and post-training observational coding of standardized patient assessments indicated significant improvements in usage of the following skill categories: total skill use, information organization, and empathic communication (p < .001). Overall, these results suggest that communication skills training for student nurses is a feasible, acceptable, and effective way of increasing confidence and skills usage in complex clinical scenarios.

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.

"I'm scared": Journaling Uncovers Student Perceptions Prior to a Psychiatric Clinical Rotation

BACKGROUND: The United States is experiencing a shortage of mental health practitioners. A growing body of evidence shows that nursing students state that mental health is among the least desirable specialties, citing anxiety as a prominent factor. This study builds on existing knowledge and seeks to understand undergraduate nursing students' goals and perceptions about mental health prior to a mental health course utilizing a semistructured clinical journal. AIMS: To explore undergraduate nursing students' goals and perceptions in order to develop strategies that may positively influence students' thoughts about mental health nursing. METHOD: Utilizing qualitative methodology, students' journal entries (n = 90) were coded into keywords by frequency, forming the basis of themes in this study. RESULTS: Analysis found that nursing students are primarily concerned with their ability to communicate effectively with mental health patients, leading to fears about the upcoming mental health practicum. Although not prompted, students also discussed various stigmas surrounding mental health patients and disorders. CONCLUSION: Students enter the mental health course and practicum with a variety of preconceptions. Nurse educators play a central role in identifying and developing psychoeducational strategies to address student concerns and increase students' interest in mental health nursing.

Attitudes towards psychiatry amongst medical and nursing students in Singapore

BACKGROUND

A shortage of specialists in psychiatry, both in terms of psychiatrists and psychiatric nurses is evident worldwide. While there are multiple factors leading to an individual's decision to specialize in psychiatry, the individual's perceptions and attitudes towards psychiatry tend to play an essential role. This study thus aimed to explore attitudes towards psychiatry amongst medical and nursing students in Singapore and examine factors associated with these attitudes.

METHODS

The present cross-sectional study used an online web survey tool to assess attitudes towards psychiatry amongst 502 medical and 500 nursing students in Singapore using the Attitudes towards Psychiatry (ATP-18) scale. Descriptive statistics and multiple linear regressions were used to examine associated factors (sociodemographic and education).

RESULTS

The majority of students in this population endorsed favourable attitudes towards the following aspects of psychiatry: challenges within psychiatry, importance of psychiatry and psychiatric skills, treatment efficacy and view towards psychiatrists, but had generally unfavourable attitudes towards psychiatric patients. Male participants (compared to female; β = - 1.190, p < 0.05), participants in the middle income group (compared to higher income group; β = - 0.945, p < 0.05), participants who rated average for psychiatry lecture course and psychiatry clinical placement course (compared to above average; β = - 1.654, p < 0.05; β = - 1.181, p < 0.05) had a less favourable attitude to psychiatry. Not surprisingly, participants who were more likely to specialize in psychiatry (β = 2.053, p < 0.001) had a more favourable attitude towards psychiatry compared to those who were less likely to specialize in psychiatry.

CONCLUSIONS

The majority of students in this study endorsed unfavourable attitudes towards patients in the psychiatric setting. The present psychiatry curriculum could be improved to nurture the development of empathetic attitudes towards people with mental illness. De-stigmatization strategies could also be integrated into other curricula besides psychiatry.

Facilitating student learning with critical reflective journaling in psychiatric mental health nursing clinical education: A qualitative study

BACKGROUND

Critical reflective journaling has been used to facilitate student learning in various disciplines; however, there is only limited data available on its application in clinical education in the area of psychiatric mental health nursing.

OBJECTIVES

The aims of the study were to: 1) explore types of events or issues that senior nursing students chose to reflect upon in their critical reflective journals during their 5-week psychiatric mental health nursing clinical practicum; and 2) assess students' evaluations of critical reflective journaling.

DESIGN & METHODS

For this qualitative study, we collected data from senior nursing students who were enrolled in the mental health clinical practicum from March to June 2016 and agreed to participate in the study. During the 5-week psychiatric mental health nursing clinical practicum, students completed four weeks of clinical rotations in two units and submitted one journal entry each week reflecting upon an instance they selected and completed a survey to evaluate critical reflective journaling. De-identified data were analyzed using qualitative content analysis.

RESULTS

We analyzed 236 journal entries and survey results completed by 59 students. Students chose to reflect upon the following issues: boundaries of therapeutic relationships, responses to patient symptoms, and own attitudes and biases toward mental illness. They reported that critical reflective journaling provided them opportunities for self-reflection and self-emancipation, which led to increased motivation for full engagement in the clinical practicum and increased understanding of patients' perspectives as well as mental health nursing competency. Overall, students were satisfied with critical reflective journaling but also identified areas for improvement in regard to its application in clinical education.

CONCLUSIONS

Through critical reflective journaling, nursing students are able to self-reflect on issues arisen during their clinical rotation, which leads to improvement of their competency in psychiatric mental health nursing and full engagement in the clinical practicum.

The use of psychiatry-focused simulation in undergraduate nursing education: A systematic search and review

Evidence on the use of simulation to teach psychiatry and mental health (including addiction) content is emerging, yet no summary of the implementation processes or associated outcomes exists. The aim of this study was to systematically search and review empirical literature on the use of psychiatry-focused simulation in undergraduate nursing education. Objectives were to (i) assess the methodological quality of existing evidence on the use of simulation to teach mental health content to undergraduate nursing students, (ii) describe the operationalization of the simulations, and (iii) summarize the associated quantitative and qualitative outcomes. We conducted online database (MEDLINE, Embase, ERIC, CINAHL, PsycINFO from January 2004 to October 2015) and grey literature searches. Thirty-two simulation studies were identified describing and evaluating six types of simulations (standardized patients, audio simulations, high-fidelity simulators, virtual world, multimodal, and tabletop). Overall, 2724 participants were included in the studies. Studies reflected a limited number of intervention designs, and outcomes were evaluated with qualitative and quantitative methods incorporating a variety of tools. Results indicated that simulation was effective in reducing student anxiety and improving their knowledge, empathy, communication, and confidence. The summarized qualitative findings all supported the benefit of simulation; however, more research is needed to assess the comparative effectiveness of the types of simulations. Recommendations from the findings include the development of guidelines for educators to deliver each simulation component (briefing, active simulation, debriefing). Finally, consensus around appropriate training of facilitators is needed, as is consistent and agreed upon simulation terminology.

Effect of immersive workplace experience on undergraduate nurses' mental health clinical confidence

Preregistration education needs to ensure that student nurses are properly trained with the required skills and knowledge, and have the confidence to work with people who have a mental illness. With increased attention on non-traditional mental health clinical placements, further research is required to determine the effects of non-traditional mental health clinical placements on mental health clinical confidence. The aim of the present study was to investigate the impact of a non-traditional mental health clinical placement on mental health nursing clinical confidence compared to nursing students undergoing traditional clinical placements. Using the Mental Health Nursing Clinical Confidence Scale, the study investigated the relative effects of two placement programmes on the mental health clinical confidence of 79 nursing students. The two placement programmes included a non-traditional clinical placement of Recovery Camp and a comparison group that attended traditional clinical placements. Overall, the results indicated that, for both groups, mental health placement had a significant effect on improving mean mental health clinical confidence, both immediately upon conclusion of placement and at the 3-month follow up. Students who attended Recovery Camp reported a significant positive difference, compared to the comparison group, for ratings related to communicating effectively with clients with a mental illness, having a basic knowledge of antipsychotic medications and their side-effects, and providing client education regarding the effects and side-effects of medications. The findings suggest that a unique clinical placement, such as Recovery Camp, can improve and maintain facets of mental health clinical confidence for students of nursing.

Nursing students' reflections on the learning experience of a unique mental health clinical placement

INTRODUCTION

There exists a need for innovative thinking to identify new clinical placement opportunities for nursing students. Recovery-based clinical placements for mental health nurse students remain unique and require investigation.

AIM

To examine the learning experience of Bachelor of Nursing students who undertook an innovative mental health clinical placement known as Recovery Camp.

DESIGN

This study incorporated qualitative analysis of written reflections. Using Braun and Clarke's (2006) six phases of thematic analysis the corpus of student reflections were reviewed by three members of the research team independent to each other.

FINDINGS

Four themes emerged. The theme of Pre-placement Expectations incorporates participant foci on pre-conceptions of Recovery Camp. The theme of Student Learning incorporates the ways in which participants recognised the experience of Recovery Camp influenced learning. Reflections themed under the title Placement Setting include discussion of the Recovery Camp as a clinical placement. The theme of Future Practice incorporates students' reflections on how they plan to practice as nurses as a result the learning experiences of Recovery Camp.

CONCLUSIONS

An immersive clinical placement such as Recovery Camp can influence students' perceptions of people with mental illness, have a positive impact on student learning and influence students' decisions about future practice. The learning experience of nursing students whom attend unique, recovery-orientated clinical placements can be both positive and educative.

Evaluation of undergraduate nursing students' clinical confidence following a mental health recovery camp

In the present study, we evaluate the impact of participation in a mental health recovery camp on the clinical confidence of undergraduate nursing students in dealing with individuals with mental illness. Twenty undergraduate nursing students who participated in the recovery camp completed the Mental Health Nursing Clinical Confidence Scale both before and directly after attending the camp. Data were analysed using descriptive and inferential statistics. Participation in the recovery camp was associated with a statistically-significant increase in students' level of overall confidence between the pretest and post-test data (P < 0.005). The results also demonstrated that students over the age of 25 years and who do not have a family history of mental illness are more likely to self-report a higher level of confidence in both the pre- and post-results. The clinical confidence of undergraduate nursing students improved through participation in an immersive clinical experience within the recovery camp.

Assistants' in nursing perceptions of their social place within mental health-care settings

An international nurse shortage, tightening fiscal constraints, and increased service demands have seen health systems increasingly turn to employing assistants in nursing (AIN) as a cost-effective means to meet demand. This paper describes social positioning from the perspective of 11 AIN who were employed to work in specialist mental health settings in a metropolitan health service in Sydney. Data was collected by means of semistructured interviews. Interview questions encouraged AIN to explore their experience with reference to positioning within the service, role perception, role development, staff relationship, and role satisfaction. Thematic analysis was utilized to generate themes and explore meaning within the data. The following themes emerged: role definition and clarity; socialization and adaptation; and enhancing education. Analysis suggests that whilst AIN were integrated into mainstream service, the scope of activities or role remains geographically variable and inconsistent. Encouragingly, as AIN became familiar with their work environments and teams, they considered themselves to be of value and were able to play a meaningful role. A desire for learning and a need for continuing education also emerged as a primary theme. Findings from the data suggest that AIN in the mental health setting remain a novel and, to some extent, poorly utilized resource.

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.

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.

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.

An interpretive study of nursing students' experiences of caring for suicidal persons

Suicide is a worldwide public health problem. Although preparing nursing students to care for suicidal persons has been a standard part of nursing education for many years, nurses consistently report that they lack competencies in caring for this population of patients. The purpose of this phenomenological and hermeneutical study was to understand the experiences undergraduate nursing students had in regard to caring for suicidal persons. The aim of the study was to obtain insights into the basic preparation of students in the care of suicidal persons to inform pedagogical approaches pertaining to suicide and improve the nursing care for these individuals. Twelve senior nursing students were recruited for the study. Data were collected using in-depth, unstructured interviews. The study themes indicated that (a) when participants read about suicidal persons' mental status and behavior in patient, records they initially feared interacting with and caring for these individuals; (b) participants' abilities to gather information about suicide risk was influenced by how much patients talked with them about their suicidal tendencies; and (c) participants' capacity to provide safe and therapeutic suicide prevention interventions was impacted by judicious critical thinking skills. Teaching strategies that align with the themes are provided.

Student nurses and the general population in Sweden: trends in attitudes towards mental illness

OBJECTIVE

To evaluate attitudes towards mental illness displayed by student nurses' with previous contact with mentally disordered persons prior to education in psychiatric nursing and to evaluate trends in attitudes towards mental illness exhibited by student nurses and the public in Sweden.

METHODS

Altogether 246 student nurses enrolled in three universities in Sweden (mean age = 27.9 ± 7.5 years) out of which 210 were females and 36 males, completed prior to their obligatory course in psychiatric nursing a shortened version of 11 internally reliable (Cronbach's alpha 0.84) items from the Swedish version of the Community Attitudes towards Mental Illness questionnarie. The selected items were named the Student Nurse Attitude Index (SNAI) and formed the basis for an evaluation of trends exhibited by student nurses and the attitudes of the general population towards mental illness by means of Jonkheere's trend test. By linear regression analysis, the impact of previous contact with mental illness on student nurses' attitudes towards mental illness prior to education in psychiatric nursing was assessed.

RESULTS

Student nurses did not demonstrate, in contrast to the public in Sweden, a trend of positive attitudes toward persons with mental illness. Even so, it was revealed that student nurses who had experienced some type of contact with mental illness prior to education in psychiatric nursing exhibited a positive attitude, more so than those lacking contact, toward mental illness.

CONCLUSIONS

The findings corroborated the "contact hypothesis", implying that direct contact with persons with mental illness will encourage acceptance and enhance a positive attitude towards mental illness in general.

Views and experiences of mental health nurses working with undergraduate assistants in nursing in an acute mental health setting

Undergraduate nurses are employed as assistants in nursing (AIN) in inpatient mental health settings; however, there is a paucity of published research exploring registered nurses' (RN) views about the AIN role in these settings. This qualitative study documents the views and experiences of RN working with undergraduate AIN. Fifty structured face-to-face interviews were analysed, and the results are discussed in three sections. The first section outlines RN perceptions of qualities and skills required of AIN in mental health, and the responses primarily focus on communication skills, initiative, and willingness to learn. The second section targets factors in the workplace that might enhance the interest of AIN in a mental health nursing career; the responses emphasize their need to work with experienced staff. The last section outlines RN expectations of AIN, most of which are met and involve physical observations and technical tasks; less fulfilled activities primarily cluster around interactions with patients. Findings highlight the advantages and disadvantages of drawing on undergraduate nursing students as AIN in mental health settings. Communication skills, personal initiative, safety training to prevent violence, and education to increase knowledge and awareness about mental illness, diagnosis, and mental status-related skills were all important concerns articulated by RN.

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.

Mentoring experiences of psychiatric nurses: from acquaintance to affirmation

Mentoring is regarded as involving a voluntary and mutually beneficial relationship in which one person is experienced and knowledgeable (mentor) who supports the maturation of a less-experienced person (mentee). While there have been studies on mentorship in a wide range of areas within nursing, so far studies on psychiatric nursing are scarce. The hallmark of psychiatric nursing is the use of interpersonal process as a means of bringing about positive health changes in the clients. If psychiatric nurses are involved in mentorship, they can, through experiential learning, be nurtured to use interpersonal process as therapeutic tools in their work more effectively. This study examines the mentorship experiences of psychiatric nurses. Personal accounts of 27 psychiatric nurses were analyzed using qualitative methodology. Results of the study shed light on the role of mentorship in facilitating the socialization of psychiatric nurses and revealed the main aspects involved in this process. Four themes experienced by mentees during the mentoring process are the key to its success. These are: becoming acquaintances, developing bond, feeling being included and obtaining affirmation. These themes were found to be progressive in terms of mentees' degree of connection with their mentors and their involvement in the nursing profession.

Learning from the world of mental health care: nursing students' narratives

This narrative study describes the substance of nursing students' learning in the area of mental health and their responses to the challenges of working in the psychiatric field. The data consisted of 39 critical incidents written by 20 Finnish second-year nursing students during their 5-week mental health placement. The narrative analysis method was used in the data analysis and the configuration of three consistent learning storylines: self-awareness and self-esteem, the nurse-patient relationship and mental health care methods. The three storylines characterized the essence of the students' learning and their responses to the challenges of the psychiatric field during the placement. The students were actively exposed to complicated care situations and patient encounters in which they had to face their own emotions and test coping skills. It seems that the critical incident technique stimulated students' narrative skills and possibly sensitized them for listening at the stories of their future patients.

Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes

Background

The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes.

Methods

General hospital health professionals in Malaysia were randomly allocated one of two vignettes, one describing a patient with mental illness and the other a patient with diabetes, and invited to complete a questionnaire examining attitudes and health care practices in relation to the case. The questionnaires completed by respondents included questions on demographics, training in mental health, exposure in clinical practice to people with mental illness, attitudes and expected health care behaviour towards the patient in the vignette, and a general questionnaire exploring negative attitudes towards people with mental illness. Questionnaires with complete responses were received from 654 study participants.

Results

Stigmatising attitudes towards persons with mental illness were common. Those responding to the mental illness vignette (N = 356) gave significantly lower ratings on care and support and higher ratings on avoidance and negative stereotype expectations compared with those responding the diabetes vignette (N = 298).

Conclusions

Results support the view that, in the Malaysian setting, patients with mental illness may receive differential care from general hospital staff and that general stigmatising attitudes among professionals may influence their care practices. More direct measurement of clinician behaviours than able to be implemented through survey method is required to support these conclusions.

Attitudes of undergraduate health science students towards patients with intellectual disability, substance abuse, and acute mental illness: a cross-sectional study

BACKGROUND

There is a long history of certain medical conditions being associated with stigma, stereotypes, and negative attitudes. Research has shown that such attitudes can have a detrimental effect on patients presenting with stigmatised medical conditions and can even flow on to impact their family. The objective of this study was to measure the attitudes of undergraduate students enrolled in six different health-related courses at Monash University toward patients with intellectual disability, substance abuse, and acute mental illness.

METHODS

A convenience sample of undergraduate students enrolled in six health-related courses in first, second and third years at Monash University were surveyed. The Medical Condition Regard Scale--a valid and reliable, self-report measure of attitudes--was administered to students along with a brief demographic form. Mean scores, t-tests, and ANOVA were used to analyse student attitudes. Ethics approval was granted.

RESULTS

548 students participated. Statistically significant differences were found between the courses (p = 0.05), year of the course (p = 0.09), and gender (p = 0.04) for the medical condition of intellectual disability. There was no statistically significant difference between the courses, year of the course, gender, and age group for substance abuse or acute mental illness conditions.

CONCLUSION

The findings suggest that students in undergraduate health-related courses, as a group, have a strong regard for patients with intellectual disability and some regard for patients with acute mental illness, but not for patients presenting with substance abuse problems.

Reporting behaviours of nursing students who have experienced verbal abuse

AIM

This paper is a report of a study exploring the reporting behaviours of nursing students who had experienced verbal abuse while gaining clinical experience.

BACKGROUND

Under-reporting of incidents of verbal abuse has been identified internationally as a limitation leading to incomplete data collection when researching aggression in healthcare facilities. This can call into question conclusions, recommendations and policy initiatives based on the research.

METHOD

Questionnaires were distributed in 2005 to a convenience sample of 156 third year nursing students from one preregistration nursing programme in England. A total of 114 questionnaires were returned, giving a response rate of 73.0%. Fifty-one students (44.7%) reported verbal abuse and all of these gave details of the behaviours concerned.

RESULTS

Thirty-two students (62.7%) of those reporting verbal abuse) stated that they had reported the incident and 19 (37.3%) of respondents stated that they had not. Only four incidents resulted in formal documentation. The most frequent feelings reported by respondents were embarrassment and feeling sorry for the abuser.

CONCLUSION

Failure to document experiences of verbal abuse formally was prevalent and reporting practices were variable. Both higher education institutions and healthcare providers should consider establishing process for formal reporting and documenting of incidents of verbal abuse during nurse education, and students should have access to formal support services.

Communication and human patient simulation in psychiatric nursing

Communication is an integral component of nursing education and has been shown to improve health outcomes, patient compliance, and patient satisfaction. Psychiatric nursing emphasizes knowledge and utilization of communication skills. Nursing students often express anxiety and lack of confidence regarding communicating with patients diagnosed with psychiatric illnesses. Human patient simulation is one method that may be used for students to practice and become proficient with communication skills in a simulated environment. The authors of this article provide an overview of communication and psychiatric nursing as well as review of the current research related to the use of human patient simulation in nursing education.

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.

Clinical experience in mental health nursing: determining satisfaction and the influential factors

Clinical exposure to the mental health environment has been identified as a major factor in promoting a more favourable attitude towards mental health nursing. However, little attention has been devoted to measuring specific aspects of the clinical placement experience. This paper presents the findings of a survey of 703 undergraduate nursing students designed to measure satisfaction and identify factors influencing satisfaction (length and type of placement, time spent with a preceptor). A questionnaire was administered to undergraduate nursing students in Victoria, Australia, at the conclusion of their clinical experience in mental health. The findings demonstrate a high level of satisfaction, particularly in feeling welcomed, well oriented and supported, and opportunities for patient care. Students' views were influenced by the duration and type of placement and time spent with a preceptor. These findings provide valuable information about characteristics of a positive clinical experience that should be considered in structuring clinical placements in the mental health field.

Developing more positive attitudes towards mental health nursing in undergraduate students: part 1--does more theory help?

Negative attitudes towards mental illness and the mental health nursing profession have deterred many undergraduate nursing students from considering this area as an attractive career option. Positive clinical experience has been identified as the most important factor in producing more favourable attitudes. While the quantity of theory is identified as important, its impact on attitudes has not been examined through research. This study compared two groups of students undertaking different numbers of theoretical and clinical hours in mental health nursing to determine if this increase has an impact on nursing students' attitudes. Anonymous questionnaires were distributed to the total population of students following completion of the theoretical component of the programme but prior to clinical experience. The questionnaire was designed to assess: (1) nursing student's preparedness for and attitudes towards the mental health field; (2) consumers of mental health services; and (3) the students' career preferences. This first paper in a two-part series examines the impact of theoretical hours and suggests that while other attitudes are fairly similar between the two groups, the group exposed to more theory exhibited significantly more positive attitudes towards psychiatric nursing as a career.

Improving the undergraduate clinical placement experience in mental health nursing

Recruitment in mental health nursing is an international problem. Improving the undergraduate clinical placement experience may help to attract students into mental health nursing. In this paper, the authors describe the development and evaluation of a clinical facilitation program aimed at improving the placement experience. Students were surveyed about their attitudes to mental health nursing before and after placement. Based on the results from 254 pre-placement and 248 post-placement surveys there was a large significant increase in students' interest in mental health nursing following clinical placement. Data collected from focus groups also indicated that facilitators, students, and clinical nurses all viewed the program positively.

Emotional learning within the framework of nursing education

Nursing requires a certain degree of emotional investment as well as the capacity to align one's emotions to the norms and values of the profession. The article is based on a qualitative study among nursing students in Norway. It discusses how peer learning in connection with sessions involving role-play may contribute to developing these qualities in future professionals. As researchers, we acquired access to a particular communication course for the third year nursing students at Oslo University College. The study combines two methodological approaches: observation and focus group interviews. The findings illustrate how students, by commenting on each others' experiences and performance, may be able to help each other to develop a richer repertoire in how to express themselves and to adapt their behavior to the needs of those being cared for.

Working together: a joint initiative between academics and clinicians to prepare undergraduate nursing students to work in mental health settings

There is ongoing concern among mental health professionals regarding the recruitment of newly graduated nurses to this specialist nursing area. Many reasons for the problem have been identified, including the perceived inadequate preparation by the tertiary sector, students' prejudices and anxieties about mental illness, a perceived lack of support while undertaking clinical placement, and the quality of the clinical placement itself. This paper describes a collaborative response to these issues undertaken in the Illawarra region of New South Wales, Australia. The implementation of preclinical undergraduate workshops using problem-based learning and role plays were undertaken. Mental health nursing scenarios were developed in association with experienced clinicians to introduce core concepts in a supportive learning environment. Quantitative and qualitative evaluation data were collected immediately following the workshop and again after the students returned to the university following a mental health clinical placement. A further survey of one cohort was undertaken 12 months after initial state registration and the beginning of a career in mental health nursing. Results showed that both students' and clinicians' attitudes to the workshops were consistently positive and indicated that the workshops were beneficial in preparing students for their clinical placement. Importantly, since the implementation of the workshops and other collaborative initiatives, an increasing number of newly graduated nurses from the region are choosing to work in mental health.

So what is so good about clinical experience? A mental health nursing perspective

The available literature suggests that undergraduate nursing students generally do not have positive attitudes towards working in the mental health field but that clinical experience is the most important factor influencing the development of a more favourable outlook. Despite this there is very little attention paid to the factors that contribute to a positive clinical experience. The aim of this paper is to examine the level of, and factors contributing to, undergraduate nursing students' satisfaction with clinical experience. A survey was administered to undergraduate nursing students (n=146). The findings support the available literature in suggesting that the provision of support and the ability to become actively involved in patient care are the two most important factors affecting the perceived quality of clinical placements. However, this study contradicts the findings of earlier research in demonstrating a higher degree of satisfaction with clinical experience in inpatient settings. This reflected the view that there was less opportunity for patient care involvement within the community environment. Given the increased emphasis on community care, it is important that students are actively engaged in the care and treatment process in order that they have the opportunity to meet learning objectives in the mental health field.

Reflecting during clinical placement - Discovering factors that influence pre-registration psychiatric nursing students

As the debate surrounding reflection continues there are recommendations that Irish pre-registration nurses should use reflection as a strategy to facilitate the development of competencies. In one School of Psychiatric Nursing, diploma student psychiatric nurses were already using reflection as an aid to develop their competencies in the course of their clinical placements. The aim of this study was to explore student psychiatric nurses' perceptions of reflection as a learning strategy during clinical placement. Using a constructivist qualitative methodology third year students were interviewed individually in their clinical placements. Data analysis revealed three major categories: understanding the process of reflection, using reflection in clinical practice, and needing support and guidance. The latter category, which is explored in this paper, indicated that a number of factors influenced how students engaged in reflection during clinical placement. Findings also indicated that the mentor, the clinical placement co-ordinator and the lecturer have key roles. It is suggested that as students need more adequate preparation and ongoing support to reflect that a collaborative approach between health service providers and the learning institution, regarding the development of reflective strategies, is vital if reflection is to be an effective learning tool in clinical placements.

Coping with uncertainty within the preceptorship experience: the perceptions of nursing students

A substantial amount of time and resources are channelled into supporting clinical practicum in nursing education programmes. Attention is targeted at the most effective models to achieve this aim. The provision of sound support models regardless of specific clinical setting is recognized as integral to student development and transition periods throughout nurses' careers. Within the mental health setting, this situation is compounded by the negative attitudes nursing students tend to hold towards people experiencing a mental illness. Preceptorship has been widely used both nationally and internationally for clinical practicum. Although this model seems to have been endorsed by virtue of its increasing use, additional examination is necessary to assess efficacy and effectiveness across clinical practicum, including those in mental health settings. In utilizing a grounded theory approach, this study addresses the question: what is the experience of preceptorship for undergraduate nursing students in the mental health setting? The major themes identified include: 'fear of the unknown', 'reconciling difference between general acute health and mental health settings' and 'supporting practice'.