Mental health in nursing degrees

Image sourced here under Creative Commons license.

“When it comes to mental health, there is insufficient preparation of undergraduate nurses within the Bachelor of Nursing,” … “This is partly because there aren’t available clinical placements in the field, but also because of the stigma perpetuated by some academics and Registered Nurses.”

Professor Eimear Muir-Cochrane in Australian Nursing and Midwifery Federation (SA Branch), January 2019, In Practice, p.5.

Based on my EN experiences and the look on people’s face when I mention I am interested in mental health nursing, I never expected mental health to be a highly popular field amongst nursing students. I even hoped it would make it easier to preference a mental health placement. However I was quite surprised after reading the above to discover there was a complete lack of mental health placements in South Australia. I asked Twitter if this was widespread or isolated to South Australia to discover in some states it is mandatory to undertake at least two weeks placement in mental health, and some universities even offer a mental health major.

I am quite disappointed I will not have a placement opportunity which could help to confirm my interest in the field or help me decide that it may not actually be right for me. Other students may even discover a new-found interest on placement they otherwise would not have been exposed to, or at the very least gain an appreciation of the relevance of mental health care.

Additionally, there appears to be minimal mental health theory taught in some nursing degrees, such as the programs I applied for that do not seem to have dedicated mental health subjects. The federal government has acknowledged the inconsistency across degrees and last year signalled a plan to create a national framework for consistent content, although consistent may not necessarily mean adequate.

Mental health is not a domain only serviced by specialist mental health nurses. All nurses, no matter the field, will care for mental health patients during their career. Physical and mental health conditions do not occur in isolation; the symptoms or treatment of one may exacerbate the other.

Your patient with anxiety may need extra psychological support during a procedure than other patients you have looked after, or your severely dehydrated patient who also takes lithium may require monitoring for signs lithium toxicity. Sometimes acute mental health patients are admitted to general wards while they wait for a mental health bed and they also require competent supportive care.

Similarly, diagnostic overshadowing [1] can have major consequences for mental health patients and I wonder, without a solid understanding of mental health and perhaps experience, how well nurses could ensure they do not succumb to this.

I have come across many nurses whom have so little mental health knowledge they do not know what to do when they are allocated a patient with an acute mental health condition in addition to the physical condition they have been admitted for. On medical wards I have witnessed nurses become distant and provide suboptimal care as they try to avoid their own discomfort. I have seen patients unnecessarily physically or chemically restrained because of staff attitudes (“I’m not in the mood to deal with him today”) and inadequate mental health skills to provide appropriate care [2].

I am undertaking a grad-entry nursing program as I have previously completed a different degree. There are a number of these across the country as either entry into the 2nd year of a Bachelor or as a Master degree. Qualification as an RN requires two, rather than the usual three years of study. For those undertaking a 3-year degree I understand there needs to be at least one initial course allowing students to adapt to university-style learning, however if the rest of first year is seemingly irrelevant to fulfilling the NMBA Standards for Practice, could there not be more mental health content in place of some of this? The small number of grad-entry students would miss out, but the majority would benefit.

I have barely been an RN student for five minutes, have been out of the nursing field entirely for twelve years, and have no teaching or research qualifications in this area whatsoever so may not be particularly qualified to make the comments I have. The situation is probably far more complex than my understanding and if I have misunderstood any of the above, I am more than happy to be corrected. I also understand there are likely to be numerous fields competing for more exposure in undergraduate learning, each with their own importance.

Nonetheless, mental health underpins physical health across the lifespan. Without adequate mental health we cannot look after our physical health. Should understanding and promoting mental health then, be a goal of all nurses and thus form a critical component of both theoretical and clinical training?

Footnotes

  1. Shameless self-plug, however the topic is very important and relevant.
  2. As a new and inexperienced nurse I was too intimidated to speak up to the senior nurses and doctors involved in these cases, when I was not caring for the patients in question. I realise that is a poor effort, however hope that should a similar situation arise I now have the ability to set aside my own discomfort about speaking up to better advocate on behalf of patients.
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