The importance of clinical experience for mental health nursing - part 1: undergraduate nursing students' attitudes, preparedness and satisfaction

Government inquiries and workforce data continue to draw attention to the current and impending crisis in mental health nursing. While undergraduate nursing education has been found at least partially responsible for the negative attitudes nursing students tend to hold towards mental health nursing, clinical experience has been identified as a potential strategy in enhancing more positive attitudes. However, research to date has not focused on the impact of clinical experience on specific factors such as attitudes to mental health nursing to people experiencing mental illness and perceived preparedness for the mental health field. This quasi-experimental study measured changes in students' attitudes to the three factors, including satisfaction with clinical experience following a placement in mental health nursing. A questionnaire was administered to undergraduate nursing students on the first and last day of a mental health clinical placement. This, the first of a two-part paper, compares student responses over the two-time periods and describes satisfaction with the clinical experience. The findings suggest that clinical experience in mental health nursing experience can positively influence attitudes, preparedness for practice, and the popularity of mental health nursing. Satisfaction with clinical experience was also high.     

The importance of clinical experience for mental health nursing - part 2: relationships between undergraduate nursing students' attitudes, preparedness, and satisfaction

Clinical experience is consistently emphasized in research findings as the primary influence in encouraging more positive attitudes to mental health nursing. The available research, however, presents two major limitations. First, it does not measure the specific factors that might contribute to a positive clinical experience. Second, it does not consider the relationship between clinical experience and attitudes towards people experiencing a mental illness or towards mental health nursing. This is the second of a two-part paper presenting findings from a statewide survey of undergraduate nursing students in Victoria. A pre-/post-test design was used to measure the impact of clinical experience on the following subscales: (i) attitudes towards people experiencing a mental illness; (ii) attitudes toward mental health nursing; and (iii) preparedness for mental health practice. Subscale (iv) satisfaction with clinical experience was also measured in the post-test phase. The findings demonstrated an improvement on all three subscales in the post-test phase and a high level of satisfaction with clinical experience. Furthermore, a relationship between all four subscales was evident.     

Developing more positive attitudes towards mental health nursing in undergraduate students: part 2--The impact of theory and clinical experience

Previous research examining the impact of education on nursing students' attitudes towards mental health nursing as a career has highlighted clinical experience as the primary influencing factor and generally has not considered the impact of theory. The current study compared a cohort of second-year and a cohort of third-year nursing students from the same university. Second-year students had received more theory and clinical experience than their counterparts. Questionnaires were distributed to the total population of students before commencement of, and after completion of clinical placement. This paper examines students' perceived preparedness for and satisfaction with clinical experience, attitudes towards people with mental illness, and attitudes towards mental health nursing as a career option following the completion of differing amounts of theory and clinical experience. The results demonstrate some statistically significant differences with increased amounts of theory and clinical experience in the second-year cohort being positively influential. The findings suggest that an increased component of theoretical and clinical experience in psychiatric/mental health nursing is likely to produce more positive attitudes towards people with mental illness and psychiatric/mental health nursing. However, little difference in perceived preparedness for and satisfaction with clinical experience was noted between the two cohorts.     

Cognitive dissonance and undergraduate nursing students' knowledge of, and attitudes about, smoking

BACKGROUND: Smoking is a major cause of morbidity and mortality. Although nurses have an important role in health promotion, and are well placed to see the harmful effects of tobacco smoking, studies suggest that they smoke at much the same rate as the general population. AIM: The aim of this paper is to report a study examining undergraduate nursing students' knowledge about the impact of smoking on health, and their attitudes towards smokers and smoking. METHODS: The study took place in 2001, using a non-probability sample of 366 undergraduate nursing students from an Australian university. Participants completed the Smoking and Health Promotion instrument. Festinger's theory of cognitive dissonance provided an explanatory framework for the findings. RESULTS: Most respondents who were still smoking began the habit while in high school. Students had greater generic than specialized knowledge about the effects of smoking on health, and there was no significant difference between second and third year students' knowledge. Those who still smoked had less favourable attitudes towards smoking-related health promotion than those who had never smoked or stopped smoking. Non-smokers were more supportive of non-smokers' rights than those who continued to smoke, while those who had stopped smoking were undecided. There was minimal association between levels of knowledge and attitudes about being sensitive to smoking-related health risks. CONCLUSION: The findings have implications for both high school education and undergraduate nursing education, and for the recruitment of students to undergraduate nursing programmes. More attention needs to be given in undergraduate nursing programmes to smoking and smoking-related illnesses, and to nurses' role in smoking health promotion.     

The knowledge and attitudes of mental health nurses to electro-convulsive therapy

Three hundred and forty-five questionnaires containing the knowledge and attitude scale for ECT devised by Janicak et al . (1985 ) were distributed to mental health nurses working in Wales, the data were collected from the 167 returned. Limitations in the reliability of the instrument with respect to the degree of internal consistency were found, this suggested that the knowledge statements used were inconsistent in providing a reliable measure of respondents knowledge of ECT. Findings suggested that a higher level of knowledge appeared to be associated with the length of experience of the nurse and their area of clinical practice. In addition, there were substantial variations in actual knowledge, particularly with regard to cognitive side-effects with ECT. Attitudes to ECT in this study were significantly related to the place in which the nurse was practising and the degree of contact the nurse had with patients receiving the treatment. Greater knowledge scores were obtained by those nurses who indicated a more positive response towards ECT. The conclusions suggest that knowledge of ECT required improvement in many cases, and this has implications for nurse education. A relationship between knowledge and attitudes appears to exist in this study, however, such a relationship would need to be tested further in future research.     

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.     

A quantitative study of Iranian nursing students' knowledge and attitudes towards pain: Implication for education

Rahimi‐Madiseh M, Tavakol M, Dennick R. International Journal of Nursing Practice 2010; 16 : 478–483
A quantitative study of Iranian nursing students' knowledge and attitudes towards pain: Implication for education It is well documented that pain management and pain assessment is an indispensible part of the nursing care of patients. This study sought to quantify the current knowledge and attitudes of nursing students in Iran about pain management. We conducted a cross‐sectional study using a well‐validated questionnaire entitled the ‘Knowledge and Attitudes Regarding Pain Tool’, previously used to evaluate undergraduate nursing students. Results from the survey questionnaire showed that there was a severe deficit in knowledge relating to pain and its management. It is argued that there is a real need for improving the content of pain and its management in the undergraduate nursing education curriculum, which might improve the delivery of optimal nursing care of patients. The limitations of the study are discussed and some recommendations are made for reforming pain management education for future practice.     

Quality and substance of educational strategies for mental health in undergraduate nursing curricula

In Australia, there is a workforce shortage of nurses in the mental health sector, and it is essential that universities play a part in the recruitment of nurses to work in this area. In this article, we present a literature review of educational strategies for mental health in undergraduate nursing curricula and how these align with the recommendations of the Mental Health Nurse Education Task Force. We reviewed quantitative and qualitative research from 2005 to 2012. Twelve studies from Australia and elsewhere of different types of educational courses and strategies were included for this review. The key topics identified were in relation to a general overview of programmes outlining the content and outcomes, clinical placement strategies, involvement of consumers and mental health nurses in curriculum delivery and oversight, e‐learning strategies, and implementation of mental health majors. Finally, limitations with considering the literature as a whole were highlighted, and recommendations made for future changes and research.     

Undergraduate nursing students' attitudes towards smoking health promotion

Despite the fact that nurses have a key role in health promotion, many continue to smoke at much the same rate as the general population. This paper investigates the influence of smoking status, gender, age, stage of education, and smoking duration on undergraduate nursing students' attitudes towards smoking health promotion. The study took place in one university's School of Nursing in Victoria, Australia. Respondents completed the Smoking and Health Promotion instrument. Researchers obtained ethics approval prior to commencing the study. Smoking status was the main factor that affected respondents' attitudes towards smoking health promotion, with age and education stage having a minor effect, and gender and smoking duration not significant. Nurses have an important role in modeling non-smoking behaviors for patients. There needs to be consistency between personal and professional beliefs for nurses to properly engage in smoking health promotion. The findings have implications for undergraduate nursing education curricula, nursing practice and research, and these are discussed.     

Surveying the attitudes of acute mental health nurses

Recent UK policy and guidance indicates the importance of positive attitudes towards mental health service users. This is especially true in acute inpatient care, where service users are often at their most vulnerable and have higher levels of contact with mental health staff. The following paper details secondary analysis of data collected for the validation of an attitude measurement scale with a sample of 140 nursing staff in acute settings. The results demonstrate that a wide range of attitudes are held by mental health nurses towards acute mental health care. Overall, the results indicate generally positive attitudes. Significant differences were found between qualified and unqualified staff, and males and females for some questions. Recommendations are made for future attitudinal research of mental health staff.     

Problem based learning in mental health nursing: the students' experience

Problem based learning (PBL) is well established within the field of health-care education for professionals worldwide, although little has been done to explore the experiences of students undertaking a PBL course in mental health nursing. Without firm evidence of the benefits of PBL, educationalists in mental health might be reluctant to view it as an option in curricula design. This U.K. study examined the experiences of pre-registration post-graduate mental health student nurses undertaking a 2-year educational course in which all teaching and assessment followed a PBL philosophy. Focus groups were used throughout the course to elicit in-depth qualitative data that was analysed by applying a constant comparative method. The analysis of the data uncovered the following broad themes: 'moves to autonomy, 'surviving the groups' and 'the impact of PBL'. The findings show that participants had mainly positive experiences and gained a range of study and interpersonal skills central to mental health nursing. Participants described initial anxieties resulting from engagement in PBL. However, they increasingly gained confidence in this approach, exercising increasing control over the PBL process. Despite this increased autonomy, participants continued to value the input of skilled facilitators. A recurring issue centred on the potential for interpersonal conflict within the student group and its impact on their learning. It is suggested that more research is needed examining the use of PBL in mental health nursing.     

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.