Nursing students' attitudes towards mental illness: A multi-national comparison.

Accessible Summary What is known on the subject Health professionals, including nurses, are shown to have stigmatizing attitudes towards mental illness. For nursing students who are in their formative years of professional development, mental illness stigma can severely impact the care they provide. Little research has investigated multi-national comparisons of nursing students' attitudes towards mental illness. What this paper adds to existing knowledge This study shows that between countries, there were substantial differences amongst nursing students in stigmatizing attitudes towards mental illness. Cultural perspectives may explain some of these differences. What are the implications for practice Regardless of location, stigmatizing attitudes are present at varying levels. Each nation can take steps to reduce these by acknowledging the presence of stigmatizing attitudes amongst nurses, educating nurses regarding the negative impacts of stigma on patient outcomes, and decrease stigmatizing attitudes by facilitating opportunities for nurses (particularly student nurses) to have direct contact with people with lived experiences of mental illness. ABSTRACT: INTRODUCTION: Stigmatizing attitudes perpetuated by nursing professionals are a pervasive problem for people experiencing mental health issues. This global issue has detrimental consequences; inhibiting one's life chances and help-seeking behaviours. To date, few studies have compared nursing students' attitudes towards mental illness from a multi-national perspective. AIM: To compare undergraduate nursing students' attitudes towards mental illness across six countries: Australia, India, Jordan, Saudi Arabia, Taiwan and USA. METHOD: In a cross-sectional design, data were collected from undergraduate nursing students (N = 426) using the Social Distance Scale. A one-way analysis of variance was used to compare differences between countries. RESULTS: Nursing students' attitudes to mental illness differed between countries. Social Distance Scores were highest amongst nursing students from Jordan and Saudi Arabia. Students from Taiwan and India possessed moderate stigma scores. Social Distance Scores from the USA and Australia were lowest. DISCUSSION: Clear differences in stigmatizing attitudes emerged between countries; these are discussed in relation to possible cultural influences. IMPLICATIONS FOR PRACTICE: It is suggested that educating nurses, combined with direct contact with people with lived experiences of mental illness, can reduce stigmatizing attitudes regardless of country, location or educational institution.

The Role of Self-Determined Motivation and the Potential for Pre-registration Student Learning: A Comparative Study within a Mental Health Clinical Placement.

Developing therapeutic relationship skills as well as clinical skill confidence is critical for nursing students. While the nursing literature has examined multiple factors that influence student learning, little is known about the role of student motivation in skill development in non-traditional placement settings. Although therapeutic skills and clinical confidence are vital across a variety of contexts, here we focus on its development in mental health settings. The present study aimed to investigate whether the motivational profiles of nursing students varied with the learning associated with developing (1) a therapeutic relationship in mental health and (2) mental health clinical confidence. We examined students' self-determined motivation and skill development within an immersive, work-integrated learning experience. Undergraduate nursing students (n = 279) engaged in five-day mental health clinical placement, "Recovery Camp," as part of their studies. Data were collected via the Work Task Motivation Scale, Therapeutic Relationship Scale and the Mental Health Clinical Confidence Scale. Students were ranked into either high (top-third), moderate (mid-third) or low (bottom-third) motivation-level groups. These groups were compared for differences in Therapeutic Relationship and Mental Health Clinical Confidence scores. Students higher in motivation reported significantly higher therapeutic relationship skills (Positive Collaboration, p < .001; Emotional Difficulties, p < .01). Increased student motivation was also associated with greater clinical confidence compared to each lower-ranked motivation group (p ≤ .05). Our findings show that student motivation plays a meaningful role in pre-registration learning. Non-traditional learning environments may be uniquely placed to influence student motivation and enhance learning outcomes.

Stigma in the media: Investigating journalism students attitudes towards mental illness.

Given the profound role that media play in public opinion, there exists an ongoing necessity to understand the portrayal of mental illness by journalists. There is a plethora of studies that have examined how mental illness is portrayed in the media, but few studies have sought to understand what journalist opinions about mental illness are, and none could be found regarding journalism students' opinions. This study aimed to bridge this gap by examining journalism student's attitudes towards mental illness using the Social Distance Scale (SDS). This study adheres to STROBE guidelines for cross-sectional studies. One hundred and seventy-two undergraduate journalism students (n = 172) completed the SDS with findings suggesting that students had moderate stigmatizing attitudes, with varying degrees of stigma present depending on the social context. Positively framed reporting and constructive media coverage surrounding mental illness may be improved by shared communication and education with health professionals who specialize in mental health: mental health nurses.

The influence of a self-determination theory grounded clinical placement on nursing student's therapeutic relationship skills: A pre-test/post-test study.

For undergraduate nursing students, an integral mode of learning is their clinical placements. Learning within the clinical setting is influenced by factors such as the facilitators, peers, unit, or department the student is placed on. What is not known is the role of a social context that is grounded in Self-Determination Theory and how this influences the development of therapeutic relationship skills among undergraduate nursing students. The aim of this study was to examine the role of autonomy support in the professional learning of undergraduate nursing students. This study employed a two-group pre-test and post-test design, with undergraduate nursing students placed in either an autonomy-supportive group or a comparison group in an Australian context. Therapeutic relationship skills were assessed at the beginning and end of their compulsory mental health clinical placement. Participants were 210 (n = 210) Australian undergraduate nursing students. Using a tertile split, 140 students were placed into one of two groups based on their perception of autonomy support at the post-test time point. Pre- and post-test therapeutic relationship data were collected for both groups. A repeated measures analysis of variance was used to examine whether engagement in different clinical placements would illicit significant differences in therapeutic relationship skills. Undergraduate nursing students who were engaged in the autonomy-supportive setting had significantly higher scores associated with the therapeutic relationship subscales: Positive Collaboration and Positive Clinical Input. The importance of the social context is underscored, which is strongly influenced by the educational leader, typically referred to as a nurse facilitator.

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.

Student beliefs about their practice within a non-traditional mental health clinical placement.

Therapeutic recreation programs utilize leisure to maximize a person's overall health and well-being. The focus of this study is a professional experience placement held within an outdoor recreation center involving student nurses and people with a lived experience of mental illness. The study aimed to explore student nurse's beliefs about their practice within the program setting. An ethnographic case study approach was used to focus on the development of student nurse practice in this setting. The analytic strategy derived the themes of the ethnographic case study, namely 'who's who', 'clinical contrast' and 'recreation as practice'. A non-traditional mental health clinical placement would seem to have the potential in providing a new set of skills and experiences to these future nurses that may complement the scope of recovery-orientated care. The therapeutic recreation program provided the student with an experience where they could develop therapeutic relationships with people a lived experience of mental illness.

Examining mental health clinical placement quality using a self-determination theory approach.

Nursing clinical placements provide a unique opportunity for students to develop and hone the skills and knowledge that will be used upon graduation in their future professional practice. There is an on-going inquiry into elements that may facilitate better leaning outcomes in a variety of teaching and learning settings, including clinical experiences. Using a Self-Determination Theory approach, this study examined whether undergraduate nursing students would benefit from immersion in an autonomy-supportive clinical setting. Using a two-group pre and post-test design, students were classified into either an autonomy-supportive or comparison clinical placement cohort and measured on their learning using the Mental Health Clinical Placement Survey. Results of a repeated measures multivariate analysis of variance indicated a significant difference on some of the measures of learning housed within the Mental Health Clinical Placement Survey with students in the autonomy-supportive group reporting higher scores at the post-test time point. Findings support the value that teaching and learning in an autonomy-supportive setting has, on the skills and educational development of students.

Expert by Experience Involvement in Mental Health Research: Developing a Wellbeing Brochure for People with Lived Experiences of Mental Illness.

This is a process paper that describes the development of a wellbeing brochure, shared between university researchers, a consumer research advocate, and fully informed by people who are living with mental illness (experts by experience). The purpose of this brochure was to provide strategies for maintaining wellbeing for EBEs, after attending a psychosocial intervention. Brochure development was guided by a mixed-methods research design, using a survey and focus group. The findings illustrate five key themes in EBEs strategies for maintaining wellbeing: good sleep hygiene, regular physical activity, maintaining a healthy lifestyle, relaxation techniques and social support. This process paper demonstrates how collaborating with experts by experience represents a valuable approach for developing mental health research and resources.

Knowledge of US Midwifery Credentials Among Members of the American College of Nurse-Midwives.

INTRODUCTION: Three midwifery credentials are granted in the United States: certified nurse-midwife (CNM), certified midwife (CM), and certified professional midwife (CPM). Confusion about US midwifery credentials may restrict growth of the midwifery profession. This survey assessed American College of Nurse-Midwives (ACNM) members' knowledge of US midwifery credentials. METHODS: ACNM members (N = 7551) were surveyed via email in 2017. The survey asked respondents to report demographic information and to identify correct statements about the education, certification, and scope of practice of CNMs, CMs, and CPMs. Responses to 17 items about all midwives certified in the United States, a 5-item subset specific to CNMs/CMs, and one item related to location of midwifery practice by credential were analyzed. RESULTS: Nearly a quarter of the membership (22.1%) responded to the survey. Higher scores on the survey indicated greater identification of correct statements about the education, certification, scope, and location of practice of CNMs, CMs, and CPMs. Significant differences in scores were found among ACNM members based on their level of education, degree of professional involvement in midwifery, and prior practice as a nurse. ACNM members with higher scores on the survey held a doctorate, worked in Region I, and had greater professional leadership involvement in midwifery organizations. Participants with less nursing experience prior to their midwifery education also scored significantly higher on the survey. DISCUSSION: Although two-thirds of respondents correctly answered items on the preparation, credentialing, and scope of practice of CNMs, CMs, and CPMs, a significant minority had gaps in knowledge. Results of this survey suggest the need for outreach about US midwifery credentials. Future research to replicate and expand upon this survey may benefit the profession of midwifery in the United States.

Students' mental health clinical placements, clinical confidence and stigma surrounding mental illness: A correlational study.

Theory and clinical practicum in mental health are an important component for students in most nursing curriculum. Some studies have shown that knowledge and confidence in caring for people with mental illness improve after mental health clinical placements while others had contrasting results. Our study examined the relationship between clinical placement, confidence and stigma surrounding mental illness. We undertook a cross-sectional, descriptive correlational study in a sample of 144 undergraduate nursing students in Singapore who had completed their theoretical and clinical practicum in mental health using the Clinical Placement Survey Clinical Confidence Scale and Social Distance Scale. Descriptive, correlations and multiple regression were used to analyse the data. The results showed the mean scores for the social distance scale, clinical confidence scale and clinical placement survey were 19.92 out of 35, 49.29 out of 80 and 103.43 out of 154 respectively. Attitudes toward clinical placement experiences were significantly correlated with both stigmatising attitudes and clinical confidence of which, intentions of working in mental health settings were specifically significantly associated with stigmatising attitudes and attitudes toward clinical placement experiences, with emphasis on greater sense of preparedness, lesser perceived anxiety and greater preference for a future career in mental health nursing. This study highlighted the need to improve current mental health clinical placements to better build nursing students' confidence in caring for mentally ill patients. The interest toward specialising in mental health nursing is still lacking in nursing undergraduate students despite mental health clinical placements.

Do Help-Seeking Behaviors Influence the Recovery of People With Mental Illness?

Personal recovery is a primary focus for health care professionals and people with mental illness, with current research focused on understanding the concepts and factors that facilitate a positive recovery journey. A person's ability to seek help is an area that has demonstrated promise. Although there is a wealth of literature that exists on the barriers to someone seeking help, there is little empirical evidence to demonstrate the connection between help-seeking behaviors and personal recovery for people with mental illness. The current study used quantitative measures to examine whether help-seeking behaviors would facilitate personal recovery. One hundred twenty people with mental illness completed two valid and reliable surveys that measured help-seeking behaviors and personal recovery. Using multiple linear regression analysis, results revealed that help-seeking behaviors significantly influenced the personal recovery of participants. Understanding the constructs that facilitate a positive personal recovery journey for a person with mental illness may be viewed as a critical area of inquiry. These results allow for future inquiry into the connection between intention and behavior, as there has been an identified disparity between the need for assistance and use of services. [Journal of Psychosocial Nursing and Mental Health Services, 57(12), 33-38.].

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.

Nursing students' self-determination: the influence on stigmatizing attitude within clinical placement settings.

The training of future health professionals is a complex and dynamic endeavour, whereby students engage in a variety of experiences and learning activities. Skills developed through classes are applied and further developed within authentic settings, such as clinical placements. While there is a wealth of literature that has examined the influence of clinical placements, less inquiry has examined whether the personal traits and/or characteristics of students play a role in their professional learning and development. Specifically, a key trait that has been viewed as influencing the education and growth of people, yet has received little focus in the nursing literature, is self-determination. Therefore, the purpose of this study was to examine whether students' self-determination influences their level of professional learning, as measured by their stigmatizing attitudes, within a clinical placement. Participants were undergraduate nursing students classified as either high or low in their self-determination and engaged in a compulsory 80-hour mental health clinical placement. Data were collected using a battery of surveys to assess their self-determination towards their work and stigmatizing attitude towards people with mental illness. Using a two-group pre test and post test design, statistical analysis revealed a significant difference whereby students with high self-determination towards work possessed less stigmatizing attitudes after completing their clinical placement. Results from this study provide empirical evidence that personality elements such as self-determination and motivation towards work can play a role in the education of future professionals.

Mental health nursing placement: A comparative study of non-traditional and traditional placement.

Professional placement experiences have been considered as an approach to improving nursing attitudes towards mental health nursing and selection of mental health nursing as a career. Mental health nursing placements are now occurring in less traditional settings, however, published research of these placements remains scarce. The aim of this non-experimental comparative study was to investigate the impact of nursing student participation in a non-traditional placement, compared to participation in traditional placement. Particular focus was on the attitudes of nursing students toward mental health nursing and career preferences. Participants of the intervention group attended the non-traditional placement, (n = 23). Participants of the comparison group attended traditional placement settings (n = 27), including placements in inpatient and community mental health. The study utilised The Preplacement Survey. Results showed significant differences in scores of the non-traditional placement Recovery Camp cohort related to reduced anxiety, reduced negative attitudes, and increased preparedness for mental health. These correlated with a comparatively increased desire to pursue a future career in mental health; albeit not a statistically significant increase. Considering mental health care, in any setting, is highly dependent on the training and ability of nurses to deliver effective service, the findings of the current study are important.

A Path Analysis of Self-determination and Resiliency for Consumers Living with Mental Illness.

Over the last three decades, resilience has become a key area in mental health research, practice and policy, due to its potential to positively impact on wellbeing and quality of life. Research findings have identified that resilience positively correlates with an individual's subjective sense of well-being and decreased mental health problems. Given the potential benefits of resilience for those living with mental illness, research should examine ways in which these individuals can increase their resilience levels. One such method of examining resilience in people living with mental illness is through a motivational lens. Using Self-Determination Theory (SDT) lens, this study examined the potential of a proposed model for understanding the correlation and influence of motivational constructs on the resilience of people with a lived experience of mental illness. Results illustrated a goodness-of-fit for the proposed model. Results can be used to illustrate the importance of motivation and self-determination for people living with mental illness.

Prior Work and Educational Experience Are Not Associated With Successful Completion of a Master's-Level, Distance Education Midwifery Program.

INTRODUCTION: In order to increase and diversify the midwifery workforce, admissions criteria for midwifery education programs must not contain unnecessary barriers to entry. Once accepted, students need to successfully complete the program. Many admissions criteria commonly used in midwifery education programs in the United States are not evidence based and could be unnecessary barriers to education. The primary objective of this study was to identify factors known during the admission process that were related to successful completion or failure to complete a midwifery program educating both student nurse-midwives (SNMs) and student midwives (SMs); a secondary objective was to quantify reasons for program noncompletion. METHODS: This master's-level, distance education program educates a diverse group of both SNMs and SMs. A pilot, retrospective cohort study examined all students matriculating at the program from fall 2012 on and scheduled to graduate by summer 2016 (N = 58). Demographic information, admissions information, academic records, and advising notes were reviewed. Reasons for noncompletion were identified, and characteristics were compared between students who did and did not complete the program. RESULTS: Program completion was not significantly associated with students' status as nurses prior to admission, labor and delivery nursing experience, length of nursing experience, nursing degree held, presence of children at home, working while in school, or undergraduate grade point average. DISCUSSION: Being a nurse, years of nursing experience, type of nursing degree, or labor and delivery nursing experience were not associated with completion of this midwifery program.

Stigmatization and self-determination of preregistration nurses: A path analysis.

The concept of stigma and the stigmatizing behaviours of health-care professionals can have a profound influence on people with mental illness. A key construct that has been identified as influencing our behaviours is self-determination. As such, in the present study, we attempted to examine the connection and influence of motivational measures on the stigmatization of preregistration nurses. Data were collected once using three surveys that measured the motivational responses and stigmatizing behaviours of preregistration nurses after an approved mental health clinical placement. Using a path analysis, the results indicated that psychological needs significantly influenced preregistration nurses' self-determination towards work. In addition, self-determination was a significant influence on the stigmatization behaviours of preregistration nurses. The results of the present study provide initial empirical evidence that supports the importance of professional self-determination and the potential connection of quality care, as illustrated with the low stigmatizing behaviours of preregistration nurses who are more self-determined towards their work/career. Because of the significant results of the present study, it is recommended that future research is needed that uses self-determination theory as a lens to understand the application and importance within the field of nurse education.

Examination of a therapeutic-recreation based clinical placement for undergraduate nursing students: A self-determined perspective.

Nursing students across the globe are expected to undertake clinical placements. To date, there have been no studies that have examined the potential educational benefits for undergraduate nursing students engaged in a mental health clinical placement grounded in self-determination theory. The present study examined the experiences of undergraduate students engaged in a mental health clinical placement termed Recovery Camp. An ethnographic methodology within a case study approach was used. The researchers were immersed in the clinical placement, which took place at a YMCA camp facility. Participants were 20 3rd year undergraduate nursing students. To gain insight and understanding, the researchers used interviews, observations, and reflective journals. The constant-comparative method was used to analyse the data. Emergent themes identified from systematic analysis were: (a) social connection and (b) experiential learning. Recovery Camp facilitated a sense of inclusion and positive/supportive behaviour. It also enhanced student learning and understanding of symptoms of mental illness. Findings from this study support and extend findings for the use of therapeutic-recreation based work placement experiences in the clinical education of future nurses. Findings demonstrated a link between this type of placement and undergraduate student's development of deeper knowledge of symptoms and experiences associated with mental illness.