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.
