Eliminating the Stigma Associated with Mental Health Nursing

Historically, Mental Health nursing has been an undervalued profession. In addition, Mental Health nursing is not regarded as a desired career option by most students or as a desired career option by most seasoned nurses. Changes in mental health nursing education/clinical rotations to improve the perceptions, attitudes, and overall experiences of the student nurse are needed. Ongoing plans to develop and implement an intensive mental health clinical experience for nursing students that focus on increased student participation and therapeutic interactions are necessary. By eliminating the vast stereotypes within mental health nursing we can begin to advance towards long term improved recruitment of a new growing workforce to adequately care for mental health patients while enjoying the benefits that this rewarding career choice can offer. Specialties Psychiatric Article

Eliminating the Stigma Associated with Mental Health Nursing

Eliminating the Stigma Associated with Mental Health Nursing through Education and the Implementation of an Enhanced Clinical Experience for Student Nurses

Don't be deluded by the L.I.E.S. : Limited Learning Experiences for Students --> Increased Fear and Anxiety towards Mental Health Patients --> Encourages Continuation of Stigma of Mental Health Nursing --> Stagnant nurse workforce and ultimately poor quality of care for mental health patients

As my senior year of nursing school approached, both the excitement and dread grew within me each day. I couldn't have been more excited to move on to advanced nursing skills and clinical rotations in the ICU. I longed for the opportunity to sneak a peek in places like the ED where nurses raced by like lightning flashes past curtained rooms assessing patient needs with optimal efficiency. When helicopters buzzed in the sky above, my neck craned to watch and wonder. Always thinking, "that is my ultimate plan... a year or two of med surg, a year or two of critical care experience, and then trauma work all the way , both on the ground and in the air".

Senior year of nursing school was also when I was scheduled to start my mental health nursing rotation. To say I had absolutely no anticipation for this endeavor is truly an understatement. This apprehension was not due to fear of the unknown, but instead a skewed vision of the importance of mental health nursing. However, I was not alone in my distaste for the clinical rotation. My fellow colleagues also had mixed emotions that the next several weeks were going to prove to be either a waste of time or the scare of their life. Much to my surprise, that first day of stepping onto the unit of my mental health nursing clinical site would be the start of what has become a sixteen year long career in psychiatric mental health nursing. Reflecting back now as an educator, I recognize how clinical experiences can significantly impact a student's career path.

The clinical experience has notoriously been a very crucial element of nursing education. It is the arena where knowledge comes to life. Students are able to make the first connection between what they have learned in theory and what they are seeing first hand.

It is exciting, it is anxiety provoking, and for some it is extremely scary. Clinical practice is an opportunity for students to begin to utilize their problem solving and critical thinking skills in real patient scenarios with the assistance and safety of their instructor. Mental health nursing clinical experiences are known to be the most anxiety producing. They have historically been minimally interactive. Students are typically only observing behaviors or staff duties on the unit. This encourages students to continue to feel afraid and worried to attempt to interact with the patients. By limiting the learning experiences of students, educators and healthcare facilities continue to not only encourage the stigma of mental health nursing as "not real nursing", but also perpetuate the stigma that mental health patients are not deserving of "real care".

Historically, Mental Health nursing has been an undervalued profession. Mental Health nurses were seen as wardens or custodians. Mental health patients were viewed as in need of containment or being locked away. Although treatment options for mental health patients are changing and care is becoming more deinstitutionalized, mental health nursing still remains an undervalued profession. Recruitment and retention are at extremely low levels when compared to other areas of nursing. Mental Health nursing is not regarded as a desired career option by most students or as a desired career option by most seasoned nurses.

A look at the NCLEX distribution plan for 2014 shows that content for Psychosocial Integrity contributes for approximately 11% of the exam.

On the contrary, nursing programs do not reflect the significance of this within their mental health courses. Changes in mental health nursing education/clinical rotations to improve the perceptions, attitudes, and overall experiences of the student nurse are needed. Ongoing plans to develop and implement an intensive mental health clinical experience for nursing students that focus on increased student participation and therapeutic interactions are necessary.

Efforts to ultimately improve the student's knowledge and understanding of the mental health patient while reducing the stigma of mental health nursing as a profession should include: a thorough conduction of a pre-assessment of student's fears and anxieties as well as mental health knowledge base prior to the first clinical experience, implementation of various education sessions with regards to topics such as Therapeutic Communication Techniques, Practice Patient 1-1 Interview Sessions, and Simulation Lab Sessions for Substance Withdrawal and Delirium, integration of guest speakers from various community mental health treatment sources throughout the semester during the theory course, additional educational sessions such as crisis intervention, group training, medication administration, etc. throughout clinical rotation, and follow- up with post clinical conferences to reevaluate the student's attitudes/ perceptions/concerns daily as well as learning needs.

By changing the way we present mental health nursing to students, we can expect the following projected outcomes: Increased student/patient interaction on the mental health unit-increased positive care outcomes/patient satisfaction, Improved results of post education/clinical experience assessments- decreased fear and anxiety, Improved knowledge base and attitudes of students as it pertains to mental health patients and nursing, Eliminating stereotypes of mental health nursing, and Advancement towards long term goals of improved nursing recruitment in the area of mental health to ensure adequate care for patients. When we focus on Intensive Education while providing ongoing support and feedback to students; Attitudes can change for the positive, Perceptions can change for the realistic, and experiences can change for the better.

Jessica S. Quigley RN, DNP

References

Grouthro,T. (2009). Recognizing and addressing the stigma associated with mental health nursing: a critical perspective.

Issues in Mental Health Nursing, 30(11):669-76.

Happell,B., Platania-Phung,C., Harris,S., & Bradshaw, J. (2014). It's the Anxiety: Facilitators and Inhibitors to Nursing Students' Career Interests in Mental Health Nursing.

Issues in Mental Health Nursing, 35(1):50-7.

Happell, B., Welch,T., Moxham,L., & Byme,L. (2013). Keeping the flame alight: understanding and enhancing interest in mental health nursing as a career.

Archives of Psychiatric Nursing, 27(4):161-5.

O'Brien,L., Buxton, M., & Gillies,D. (2008). Improving the undergraduate clinical placement experience in mental health nursing.

Issues in Mental Health Nursing, 29(5):505-22.

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Jessica Quigley

About Jessica Quigley

Jessica S. Quigley RN, DNP received her DNP and Masters in Forensic Nursing from Duquesne University. She completed her undergraduate studies in nursing at Carlow University. She works for the VA Pittsburgh Healthcare System as a Psychiatric Nurse and various universities as adjunct faculty. She resides in Pittsburgh, PA with her two sons, Patrick and Dylan and her partner, Lauren.

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Specializes in Psych.

I've been in mental health most of my career, and have seen first hand how students react while doing their mental health rotation. I've noted their anxiety levels, and fear of clients. I agree totally on that the student should be prepped prior to arriving on the unit through education. Schools should broaden their curriculum, and facilities should incorporate a larger range of participation for the students educational experience. Most students that I see remain in the nursing office watching from windows, and reading charts. Now and then they may go out and speak to a client, but they are so ill prepared for this, that the client feeds on their fears. Mental health is a challenging field, and not for everyone, however, most clients gain the ability to maintain a stable lifestyle with proper medications and therapeutic sessions. I don't think that students are aware of the population that is served, simply because of the oppression that society puts down. Its a growing field in health care, unfortunately the clinical response for nurses to meet those needs aren't being filled, causing most facilities to staff dangerously low. Hopefully with education, and concerned nurses that are willing to meet the challenge by incorporating higher learning standards..........How can I help?............Peace/Samuel.

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Specializes in mental health / psychiatic nursing.

I agree that education doesn't so much - I've only been through CNA training at this point but there was nothing on Mental Health other than "it exists." My first/current job is working for a community mental health agency in residential care - they gave me some training on mental illness as part of my orientation, but so much I've learned on the job or by actively doing research on my own. I wish there were more resources for additional training - several CNA programs used to offer continuing education courses in mental illness, dementia care etc, but all of them have now scrapped those courses.

I think the need for education is very broad - everywhere from improved clinical experiences and training for health care professionals to better educating both the patients and their families on their illness and medications. As a family member of individuals with mental illness the education and support for me as the primary caregiver was non-existent (particularly when the individual in in-patient care was discharging, I wasn't told of discharge/potential discharge until 15 minutes before I was taking him home!). I wasn't seen as a part of their world or their treatment plan - despite the fact that family and other social supports can make a big difference in patient recovery.

Complete opposite of my experience as a family caregiver going through hospice where the staff really tried to educate the whole support system of the patient on their dx and what they as family could do to support the patient. It went a long way to lowering the anxiety and stress for those of us in the family that were involved and took away the stigma that surrounds death and caring for the dying. I would really like to bring that kind of model of support and education into the mental health care arena.

In working with a population with SPMI in my current role so many of my residents don't know what meds they are on or why they are on them and it can up the paranoia level. Just taking the time to explain what a pill is and why they are on it can really cut down on the medication refusals.

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Specializes in LTC, assisted living, med-surg, psych.

My psych clinical consisted of two days in the inpatient unit. At the time I was scared, but as I got into the rhythm of the unit I realized that the patients were just regular folks who were in a mental health crisis. They could have been me.

Two decades later, it WAS me. And some of the students were very involved with us patients, while others clung to their nurses and stayed in the nurses station whenever they weren't on the floor. I'll never forget the student who spent some 1:1 time with me---she was gracious and even curious about my life with mental illness.

She didn't pretend to know more than I did about my illness, she just asked questions and listened to my answers. I hope she chooses psych nursing ; at least the nursing school has students do clinical practicum in different units now, rather than those two-day sessions that really don't teach them anything.

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Specializes in psych/dementia.

I had the same number of clinical hours for psych as I did for OB, peds, and community. The only clinical that had more was med/surg. It baffles me that some programs have so little exposure to a population that is in so much need.

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Specializes in MENTAL HEALTH, EDUCATION,ADMINISTRATION.

[COLOR=#000000][/COLOR]Thankyou for your comments Samuel. All too often nurses are not willing to assiststudents and are not very welcoming of their presence within our work space.Especially in areas such as Mental Health where students can potentially seemto be more of a hinder or cause distraction due to not being prepared or havinghigh anxiety. This is how we as nurses and educators can help... by not onlyinsisting on improved curriculum but also by simply encouraging students tolearn when they are on our unit, modeling compassion and quality nursing careof a population of patients that is all too often misjudged.[COLOR=#000000]JSQ[/COLOR]

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Specializes in MENTAL HEALTH, EDUCATION,ADMINISTRATION.

[COLOR=#000000][/COLOR]AgreedSmoup, these particular clinical areas should not be shortened or slighted.Especially when they are in such need of staff with appropriate levels ofknowledge. JSQ

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Specializes in MENTAL HEALTH, EDUCATION,ADMINISTRATION.

Thank you for sharing your story Viva. It is true you never know when you may be the one no longer "holding the keys" so to speak. ( a little psych humor) Any one of us could fall victim to the clutches of a mental disorder at any given time. None of us have a cloak of armor that protects us. The more education and awareness/exposure we can provide students the better prepared they will be and more apt at developing rapport with patients. This is what people remember, how others have made them feel.

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Specializes in MENTAL HEALTH, EDUCATION,ADMINISTRATION.

[COLOR=#000000][/COLOR]Verene,

Kudos to you for seeking out this education as you branch out into the mentalhealth field. You are correct, in hospice care the focus of an interdisciplinarytreatment team model is fantastic. Especially for making sure all of thesupport staff such as the CNA's are up to date on the care the patient requiressince they are the people on the front lines with the patient. Sadly I thinkwhen we say that nursing programs need to increase the level of education/focus for mental health then CNA programs need to begin it or restart itbecause it seems to be completely gone. This has led to a lot of both patientand staff injury/ dissatisfaction in several facilities that I have workedbecause CNA's are lacking the skills to communicate with patients in crisis andaggressive behaviors occur.

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I came to mental health nursing late in my career. It has become a true calling for me. I changed over to corrections, and I find that community mental health is grossly insufficient in my state. Go "us" for continuing to meet the challenge.

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Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

I started in mental health as a new grad. Thank u for this post. I recall in nursing school my instructor told the class how much she hated mental health nursing. I felt her comment could have adversely affected the other students perceptions of the field.

I personally don't think any nurse should hate mental health, as I believe that all fields incorporate some aspects of mental health.

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Specializes in LTC, assisted living, med-surg, psych.

Mental health may not be everyone's cup of tea, but there's no area of nursing where MH issues aren't encountered. Mentally ill people get pneumonia, have babies, need case management; that's because we're just human beings like everyone else. Nurses will often be the ones to facilitate needed care because no one else will do it. And you don't have to be a psych nurse to be that go-to person for patients who are confused and beaten down by the system. Thank God there are nurses willing to be their voice.

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