Can a clinical placement influence stigma? An analysis of measures of social distance

BackgroundThe way people who experience mental illness are perceived by health care professionals, which often includes stigmatising attitudes, can have a significant impact on treatment outcomes and on their quality of life.ObjectiveTo determine whether stigma towards people with mental illness varied for undergraduate nursing students who attended a non-traditional clinical placement called Recovery Camp compared to students who attended a ‘typical’ mental health clinical placement.DesignQuasi-experimental.ParticipantsSeventy-nine third-year nursing students were surveyed; n = 40 attended Recovery Camp (intervention), n = 39 (comparison group) attended a ‘typical’ mental health clinical placement.MethodsAll students completed the Social Distance Scale (SDS) pre- and post-placement and at three-month follow-up. Data analysis consisted of a one-way repeated measures analysis of variance (ANOVA) exploring parameter estimates between group scores across three time points. Two secondary repeated measures ANOVAs were performed to demonstrate the differences in SDS scores for each group across time. Pairwise comparisons demonstrated the differences between time intervals.ResultsA statistically significant difference in ratings of stigma between the intervention group and the comparison group existed. Parameter estimates revealed that stigma ratings for the intervention group were significantly reduced post-placement and remained consistently low at three-month follow-up. There was no significant difference in ratings of stigma for the comparison group over time.ConclusionsStudents who attended Recovery Camp reported significant decreases in stigma towards people with a mental illness over time, compared to the typical placement group. Findings suggest that a therapeutic recreation based clinical placement was more successful in reducing stigma regarding mental illness in undergraduate nursing students compared to those who attended typical mental health clinical placements.     

The Impact of High Fidelity Human Simulation on Self-Efficacy of Communication Skills

Communication is a critical component of nursing education as well as a necessity in maintaining patient safety. Psychiatric nursing is a specialty that emphasizes utilization of communication skills to develop therapeutic relationships. Nursing students are frequently concerned and anxious about entering the mental health setting for their first clinical placement. High fidelity human simulation (HFHS) is one method that can be used to allow students to practice and become proficient with communication skills. The purpose of this study was to compare the effectiveness of two educational delivery methods, traditional lecture and HFHS, on senior level nursing student's self-efficacy with respect to communicating with patients experiencing mental illness. The results of this study support the use of HFHS to assist in enhancing undergraduate students’ self-efficacy in communicating with patients who are experiencing mental illness.     

Nursing Students’ Attitudes about Psychiatric Mental Health Nursing

The purpose of this study was to describe Masters entry nursing students’ attitudes about psychiatric mental health clinical experiences; preparedness to care for persons with mental illness; students’ perceived stigmas and stereotypes; and plans to choose mental health nursing as a career. A 31-item survey was administered to pre-licensure graduate nursing students who were recruited from a Masters entry nursing program from a university in a large city in the Midwestern US. Results indicated that clinical experiences provide valuable experiences for nursing practice, however, fewer students think that these experiences prepare them to work as a psychiatric mental health nurse and none plan to pursue careers as psychiatric mental health nurses. The findings support conclusions from other studies that increasing the amount of time in the clinical setting and adding specific content to the curriculum, particularly content related to the importance of psychiatric mental health nursing and the effects of stigma, may assist the profession's efforts to recruit and retain psychiatric mental health nurses. Further research is needed to determine the effectiveness of these strategies and to identify the best ways to implement them.     

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

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

Knowledge,attitude and behaviours toward people with mental illness among Tunisian nursing students and nonhealth care students: A cross-sectional study

BackgroundAlthough being in the frontline of healthcare and having a crucial role in the reduction of stigma, evidence has shown that nurses and undergraduate nursing students hold unfavourable attitudes toward mental illness. There is, to our knowledge, no previous study that explored attitudes toward mental illness among nursing students in Tunisia, nor in North African countries.AimWe aimed to assess stigma in nursing students as compared to nonhealth care students, and the relationship between stigma and education variables in the nursing students group.MethodsThe 'Community Attitudes toward the Mentally Ill', the 'Mental Health Knowledge Schedule', and 'Reported and Intended Behaviour Scale' were administered to 255 nursing students and 332 nonhealth care students.FindingsDespite nursing students being more knowledgeable about mental disorders than nonhealth care students; they held significantly more stigmatising attitudes toward people with mental disorders in two dimensions: Authoritarianism and Community mental health ideology. After controlling for confounders, we found that having taken mental health courses significantly predicted more favourable attitudes toward people with mental disorders and better knowledge of mental health stigma. Being interested in working in psychiatric wards helped predict more favourable attitudes and intended behaviours.DiscussionIn general, results from this study are of concern as it presents evidence of an overall similar or even greater tendency to negative attitudes toward mental illness among nursing students than among nonhealth care students.ConclusionThere is an urgent need for antistigma interventions in nursing schools. These interventions should target nursing students with the most negative attitudes, including male students and those who have never had personal experience with mental illness. Interventions should also work to build up nursing students’ interest in mental health nursing during their undergraduate years.     

Undergraduate student nurses’ experience of mental health simulation pre‐clinical placement: A pre/post‐test survey

Undertaking a mental health clinical placement can be anxiety‐provoking for nursing students at times. There is a need to adequately prepare undergraduate nursing students for clinical placement in a mental health setting in relation to their skills and confidence. This study aimed to evaluate the effect of a mental health simulation workshop on the skills and confidence of nursing students in providing care to consumers living with a mental illness. The study also evaluated the design of the mental health simulation workshop from an educational perspective. A pre/post‐test survey was administered to a cohort of N = 89 Australian pre‐registration nursing students. Exploratory factor analysis identified three factors: Mental health therapeutic engagement, mental health assessment skills, and mental health placement preparedness. Analyses of pre–post differences indicated that all three factors were significantly different between the initial and follow‐up responses, with follow‐up responses being more favourable. The findings of this study demonstrate that there is value in including mental health simulated patient exercise as part of the learning strategies in the curriculum of pre‐registration nurses. This has implications for the quality of care in the clinical environment and level of preparedness of these students’ nurses for mental health clinical placement where they will be providing care to consumers living with a mental illness under direct supervision.     

Promoting the Value of Mental Health Nursing: The Contribution of a Consumer Academic

Mental illness is known to occur frequently in the general population and is more common within the general health care system. High-quality health care requires nurses to have the skills, knowledge and attitudes to provide care for people experiencing mental illness or mental distress. Research suggests health professionals, including nurses, tend to share similar negative attitudes to mental illness as the general population, and consequently, mental health nursing is not a popular career path. These two factors signify a need to influence more positive attitudes toward mental illness and mental health nursing among nursing students. A qualitative exploratory research study was undertaken to examine the experiences, opinions and attitudes of an academic and research team to the introduction of a consumer academic within an undergraduate mental health nursing subject. In-depth interviews were conducted with teaching and research team members. The importance of mental health skills emerged as a major theme and included sub-themes: mental health across the health care system; contribution of consumer academic to nursing skills; addressing fear and stigma, and inspiring passion in mental health nursing. Findings suggest academic input from people with lived experience of recovery from mental illness can influence the development of mental health nursing skills and enhance the popularity of mental health nursing as a career.     

Undergraduate nursing students' attitudes towards mental health nursing: determining the influencing factors

Available evidence clearly demonstrates that undergraduate nursing students typically hold unfavourable attitudes towards psychiatric / mental health nursing as a career. It has been suggested that students' negative attitudes towards mental illness and consumers of mental health services may be responsible for the unpopularity of this specialty area; however, research exploring the relationship between career choices and students' attitudes is lacking. A sub-set of data from a large Victorian study that examined undergraduate nursing students' attitudes towards mental illness, mental health nursing, and mental health clinical placement experiences was used to clarify the nature of this relationship. In total, complete data was available from 605 students undertaking their first mental health placement who provided responses to a 24-item pre-placement survey. This survey assessed the following three areas: 1. preparedness for the mental health field; 2. attitudes towards mental illness; and 3. attitudes towards mental health nursing. The findings demonstrate significant relationships between students' attitudes, beliefs, and characteristics and desire to pursue a career in psychiatric mental health nursing. The identification of these relationships provides a basis from which interventions to influence nursing students' attitudes towards psychiatric/mental health nursing, can be planned.     

Clinical placement anxiety in undergraduate nursing students: A concept analysis

ObjectiveThe primary aim of this review was to complete an in-depth analysis of clinical placement anxiety in undergraduate nursing students. Our overall goal was to establish a strong foundation for clinical education strategies and future research on clinical placement anxiety in nursing education.Design & methodsWe utilized Walker and Avant's systematic 8-step approach to concept analysis as a framework to develop a comprehensive understanding of clinical placement anxiety in undergraduate students.Data sourcesA review of existing literature on clinical placement anxiety was conducted using the electronic databases of PubMed, CINAHL, and PsychInfo, as well as a grey literature and snowball search. Search terms included clinical placement, clinical experience, nursing students, undergraduate nursing students, and anxiety.ResultsThe literature search resulted in 81 articles that met the inclusion criteria. Five defining attributes were identified: a vague or unknown threat, psychological-emotional responses, psychological-cognitive responses, physiological responses, and unfamiliar environments or situations. Antecedents, consequences, and empirical referents of the concept were also highlighted.ConclusionsInsights gleaned from this concept analysis may enhance the ability of clinical nursing educators to effectively prevent and manage student anxiety in the clinical setting. By contextualizing anxiety, we have also validated the importance of further exploration of the anxiety experienced by undergraduate nursing students during their clinical experiences. Thus, this concept analysis establishes the foundation for educational strategies, as well as future research in nursing education.     

Australian and Indian nursing students’ skills and attitudes surrounding mental illness: Preparing for a transnational nursing education collaboration

Cultural competence is a viewed as a necessary set of skills within nursing, and there is a need for student support in this area. This is particularly important in mental health care, with two skills considered crucial for providing quality care: therapeutic relationship skills and positive attitudes. With the objective of initiating an educational collaboration between two educational institutions, this study examined Australian and Indian undergraduate nursing student's perceived therapeutic relationship skills and stigma attitudes associated with mental illness. Participants were five hundred and fifty-five (n = 555) undergraduate nursing students from two different universities in Indian and Australia. The modified version of the Scale To Assess Therapeutic Relationship (STAR-C) and the Social Distance Scale (SDS) were both used to examine student's perceived therapeutic relationship skills and stigma attitudes. Australian nursing students indicated lower levels of stigma with lower levels of self-reported therapeutic relationships skills, as compared with the Indian nursing student cohort. However, Indian nursing students indicated higher levels of stigma with higher self-reported therapeutic relationship skills. The results of this study may reflect cultural differences and meanings attached to mental illness.     

Using standardized patients in enhancing undergraduate students' learning experience in mental health nursing

BackgroundConducting mental status examination and suicide risk assessment is an important skill required of nurses when they are in the clinical setting. With nursing students often expressing the anxiety and lack of confidence in doing so, the use of standardized patients provide an excellent opportunity to practice and become proficient with this skill in a simulated environment.ObjectivesTo explore the learning experience of undergraduate nursing students using standardized patients while practising their mental status examination and suicide risk assessment skills in mental health nursing module.DesignA pre- and post-test, single group quasi experimental design was used in this study. A standard didactic tutorial session and a standardized patient session was conducted to evaluate the learning experience of undergraduate nursing students learning mental status examination and suicide risk assessment. Outcome measures for this study include Student Satisfaction and Self-Confidence in learning scale.Qualitative comments in the form of open-ended questions were also collected in this study.SettingsA University offering nursing program from undergraduate to postgraduate level.ParticipantsA convenience sample of Year 2 undergraduate nursing students undertaking the mental health nursing module was included in this study.ResultsThe use of standardized patient session had significantly increased students' satisfaction and confidence level before they are posted to a mental health setting for their clinical attachment. There was a significant difference on students' self-confidence level for those who have taken care of a patient with mental illness after adjusting for pre-test on score in learning. Qualitative feedback obtained from students showed a positive outlook towards the use of standardized patient as an effective tool in augmenting didactic learning into practical skills.ConclusionsUsing standardized patient in mental health nursing education enhanced the integration of didactic content into clinical setting allowing students to practice their assessment skills learned in classroom and transfer it to the clinical area. The benefits of using standardized patient include allowing students to practice their communication skills and improving their confidence level in conducting mental status examination and suicide risk assessment by reducing anxiety as compared with traditional classroom and textbook-based pedagogy.     

Reflecting on Holistic Nursing: The Contribution of an Academic With Lived Experience of Mental Health Service Use

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

Undergraduate nursing students' experiences and attitudes towards working with patients with opioid use disorder in the clinical setting: A qualitative content analysis

BackgroundWith the US facing an opioid epidemic, undergraduate nursing students are increasingly encountering patients with opioid use disorder in the clinical setting. Yet, nursing curriculums have not adapted to meet this need. Previous research indicates students are exposed to negative messages that might influence their views about patients with opioid use disorder.ObjectivesThe purpose of this study was to examine nursing students' experiences encountering patients with opioid use disorder in the clinical setting, their attitudes about their encounters, and their perceptions of their educational preparedness to care for this population.MethodPurposive sampling was used to identify participants. Semi-structured interviews were conducted until saturation. Krippendorff's method for qualitative content analysis was used to cluster units within the data to identify emergent themes.ParticipantsEleven senior nursing students from a public university in New England participated.ResultsAnalysis revealed six themes, including: navigating ethical dilemmas, gaining comfort with time and experience, avoiding the “elephant in the room,” learning from real-world scenarios, witnessing discriminatory care, and recognizing bias and stigma.ConclusionsStudents were most likely to experience bias and internal conflict in maternity clinical rotations. Education should include practical communication strategies to reduce avoidance behaviors among nursing students as well as techniques to manage difficult situations and reduce moral distress. Nurses must be mindful of their power to influence students and should model non-judgmental language and behavior. Students ultimately expressed a desire to provide informed and empathetic care.     

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

IntroductionThere 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.AimTo examine the learning experience of Bachelor of Nursing students who undertook an innovative mental health clinical placement known as Recovery Camp.DesignThis 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.FindingsFour 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.ConclusionsAn 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.     

Stigmatization Behavior of Pre-Registration Nurses: Do the Self-Determined Psychological Needs Influence This?

Background/problem: Stigma and stigmatization are important concepts in the area of mental health and illness. Nursing and nurse education are continuously examining ways to understand and address the stigma toward people with a lived experience of mental illness. While the negative influence of stigma is understood, the variables that influence these behaviors are emerging. An area may provide insight into aspects that influence stigmatization of pre-registration nurses is motivation. Previous research has illustrated that individual motivation can significantly predict and influence work-related behaviors and actions across a range of work settings. Therefore, the purpose of this study was to examine the predictive influence that the motivational needs, as espoused by Self-Determination Theory, play in the stigmatization of pre-registration nurse toward people with a lived experience of mental illness. Approach: A total of 168 pre-registration nurses completed two surveys that measured support for their psychological needs and their stigmatization of people with a lived experience of mental illness. Outcomes/conclusions: Using a regression analysis, some psychological needs significantly influenced the stigmatization of pre-registration nurses. Results illustrate the potential importance of psychological needs in the training of the future nursing workforce.     

The Impact of Mental Health Nursing Module,Clinical Practice and an Anti-Stigma Program on Nursing Students' Attitudes toward Mental Illness: A Quasi-Experimental Study

BackgroundIt is important to support nursing students during their education in developing positive attitudes toward people with mental illness.ObjectivesTo examine the impact of mental health nursing module, clinical practice, and anti-stigma program on the attitudes of nursing students toward mental illness.DesignThe study was a single group pretest and posttest quasi-experimental design.SettingsThis study was conducted in a nursing school in the west of Turkey.ParticipantsThe sample of the study consisted of 64 undergraduate nursing students.MethodsThe data were collected through the Beliefs Toward Mental Illness Scale and Social Distance Scale.ResultsThe mean scores of the dangerousness subscale significantly decreased after mental health nursing module, clinical practice and anti-stigma program. The results revealed significant positive differences in the mean scores of the social distance scale after the theory, clinical practice, and anti-stigma program were completed.ConclusionsThe mental health nursing curriculum should be focused on replacing stereotypes with accurate information. Anti-stigma programs should be included in standard mental health nursing courses.     

Second-year undergraduate nursing students’ experiences with clinical simulation training in mental health clinical practice: A focus group study

AimThe aim of this focus group study was to investigate second-year undergraduate nursing students’ experiences with clinical simulation training as part of their clinical practice in acute mental health care.BackgroundThe quality of bachelor programmes in nursing has been criticised for lacking theoretical and experiential learning in the mental health modules. Novice nurses feel unprepared to care for patients with mental health challenges and graduate nurses are reported to lack the necessary knowledge and skills to manage patients with mental health issues confidently and competently. Clinical simulation training can facilitate the teaching of clinical and non-clinical skills simultaneously and is a highly suitable method within mental health care for addressing gaps in knowledge and skills in communicating with patients. Clinical simulation training may enhance nursing students' competence and thereby reduce the risk of adverse events and increase safety. However, we know little about undergraduate nursing students’ experiences with clinical simulation training as an integrated part of nursing students’ clinical practice in acute mental health wards.DesignExplorative qualitative focus group study.MethodThree focus group interviews were conducted using a semi-structured interview guide with second-year undergraduate nursing students from a university in Norway during spring 2020. In total, 14 students who had experienced clinical simulation training as part of their mental health clinical practice participated in the study. The collected data were analysed using systematic text condensation.ResultsClinical simulation training as part of the clinical practice increased the students’ preparedness, coping and self-awareness. Most of the participants had positive perceptions of the use of high-fidelity simulation-based learning. Furthermore, they highlighted three elements that increased the value of the training. First, the simulation felt authentic and increased their professional skills. Second, the standardised patient had clinical qualifications, which made the simulation feel authentic and close to realistic situations. Third, not having a former relationship with the person acting as the standardised patient enhanced authenticity.ConclusionClinical simulation training as part of clinical practice contributed to increasing the students’ self-awareness and in-depth reflection and to broadening their nursing competence. The present study lays the groundwork for future studies on clinical simulation training in mental health clinical practice for nursing students.     

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.