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Comparing student nurse experiences with developing psychiatric mental health nursing competencies in hospital and nursing homes: A mixed methods study

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Available from ProQuest Dissertations & Theses Global. (2451139812).


Nurse educators today face many barriers to attracting and retaining an adequate workforce of nurses to serve two significantly underserved and growing populations: elders and persons with mental illnesses. The primary purpose of this study was to compare and contrast how baccalaureate student nurses’ level of engagement and the perceived quality of the learning environments in inpatient mental health units and nursing homes were related to students’ (a) perceived levels of psychiatric mental health (PMH) nursing care competency, and (b) attitudes toward working with the elderly and/or mentally ill. This mixed methods case study design was guided by Bronfenbrenner and Morris’ (2006) bioecological theory of human development.

The sample included 37 junior-level nursing students and three senior-level nursing students from one baccalaureate nursing program at a medium-sized university in the Midwest who attended mental health clinical education at a nursing home for veterans or on inpatient acute mental health hospital units during 2018-2020. Linear regression, repeated measures analysis of variance (ANOVA), and independent samples t-tests were used to analyze the quantitative data collected from 37 students. A case study approach and thematic analyses were used to develop two in-depth cases using qualitative interview data from 11 nursing students in the sample pool. Finally, the quantitative and qualitative data were integrated by analyzing and interpreting points where the data were in agreement and where they diverged.

There were no statistically significant differences between the groups in perceived attainment of PMH nursing competency. Across cases, all groups made gains from a minimum of 13 points to a maximum of 36 points pre and post clinical scores for PMH nursing competency over four weeks. Across cases after attending mental health clinical, a total of 9/37 (24%) nursing students expressed they agreed or strongly agreed they were interested in a future career in mental health nursing and 5/37 (13.5%) agreed they were interested in a future career in geriatric nursing. However, there was a significant statistical difference between groups in student engagement (p = .047) and satisfaction (p = .018) with students attending mental health clinical in a nursing home being less engaged in and satisfied with clinical education than those attending on inpatient mental health units. The data supported that stigma, personal characteristics of students, peer pressure, culture, and time were factors that affected student engagement in and satisfaction with mental health clinical education.

When researching and evaluating mental health clinical education in hospital and nursing home settings, the process-person-context-time model (Bronfenbrenner & Morris, 2006) provided a robust framework to systematically study variables contributing to student satisfaction and engagement. Previous research established stigma as a significant barrier in promoting student engagement, attraction, and recruitment to future careers working with the mentally ill and elderly. There was less research about how nurse educators could counteract stigma through curriculum reform or how other factors such as time, personal characteristics of students, culture, peer pressure, and previous work experience as nursing assistants impacted engagement in and satisfaction with mental health clinical education and interest in a future career in psychiatric or geriatric nursing. More research is needed in these areas.

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