Undergraduate Nursing Students' Attitudes toward Mental Illness and Mental Health Nursing

Student summary

Why This Research Matters

Mental health nursing has a recruitment problem. Many rural communities in the United States have little or no access to mental health services, and part of the reason is a shortage of nurses who choose the specialty. This 2017 doctoral dissertation by Lois Konzelman, completed at the University of Alabama, asks a simple but important question: what shapes undergraduate nursing students' attitudes toward mental health nursing, and can nursing education itself help reduce the stigma that keeps students away from the field?

To explore this, Konzelman used Colaizzi's method of phenomenology, a qualitative research approach designed to uncover the deeper meaning behind people's lived experiences rather than measure attitudes with numbers. She interviewed 20 undergraduate BSN students after they completed their mental health nursing rotation. The study was guided by sociologist Erving Goffman's 1963 theory of stigma, which explains how societies mark certain conditions, including mental illness, as discrediting or shameful, and how that stigma can attach itself to the people and professionals associated with those conditions.

Three major themes emerged from the interviews. First, students held a wide range of attitudes toward mental health nursing, from favorable to unfavorable, and those attitudes tracked closely with how much personal experience or exposure to mental illness a student already had before starting the rotation. Students who had a family member, friend, or prior job connected to mental health tended to view the specialty differently than students encountering it for the first time in the classroom.

Second, even after finishing the course, students showed uneven understanding of the material and of what mental health nursing actually involves. Some students said they did not fully grasp the content as it was taught. Many also mentally separated illness into two boxes, medical and mental, treating psychiatric conditions as fundamentally different from physical ones rather than as part of a single continuum of health.

Third, clinical experiences and specific teaching strategies did shift attitudes, for better or worse. Students described real concerns about losing hands-on technical skills, like starting IVs or managing wound care, during a rotation that emphasizes therapeutic communication over procedural tasks. Notably, some students said they still did not fully understand what a mental health nurse's role looked like even after completing clinical placements, suggesting that exposure alone does not guarantee comprehension.

What does this mean for nursing education? The findings suggest that simply requiring a mental health rotation is not enough to build positive attitudes or a clear professional identity for the specialty. How the content is taught, how clinical placements are structured, and how faculty (including non-mental-health faculty) talk about the specialty may all shape whether students come away seeing mental health nursing as a valued, viable career path or as a lesser cousin of real nursing.

As a Canadian nursing student, you can use this study to reflect on your own program. Did your mental health rotation change how you think about the specialty, or reinforce existing assumptions? Did you notice yourself separating medical from mental problems in your own thinking? These are exactly the compartmentalizing patterns the study describes, and naming them is a first step toward more integrated, stigma-aware practice.

It is worth being clear about what this study is and is not. It is a small, qualitative dissertation based on interviews with 20 students at one American university, so its findings describe patterns of meaning among those participants rather than statistics you can generalize to all nursing students. The source record available through ERIC provides the abstract and study summary; full access to the dissertation is managed through ProQuest. Read this as a thoughtful, theory-grounded exploration of a real problem in the nursing workforce, not as a definitive measurement of attitudes across the profession.

Faculty notes

Educational Relevance

This 2017 Ed.D. dissertation by Lois Konzelman (University of Alabama) addresses a persistent workforce problem: mental health nursing struggles to recruit and retain qualified nurses, and rural American communities in particular are left with thin or absent mental health services as a result. Konzelman frames stigma, both toward mental illness and toward the nurses who care for people living with it, as a likely contributor to this shortage, and asks whether undergraduate nursing education can help counteract that stigma.

Methodologically, the study uses Colaizzi's descriptive phenomenological method, a well-established qualitative approach in nursing research that seeks the underlying structure of meaning in lived experience rather than statistical generalization. Twenty undergraduate BSN students were interviewed, and the analysis was theoretically anchored in Goffman's (1963) concept of stigma, which frames certain attributes, including mental illness, as socially discrediting.

Three major themes and several subthemes emerged. The first theme captured variability: students' attitudes toward mental health nursing ranged from favorable to unfavorable, and this variability tracked with prior experience and exposure to mental illness rather than with any single curricular input. The second theme concerned comprehension: at the end of the course rotation, students showed uneven grasp of the material, and many compartmentalized illness into separate medical and mental categories, a finding that resonates with the broader literature on biomedical versus psychosocial framings of health. The third theme concerned change: clinical experiences and specific teaching strategies produced measurable attitudinal shifts, but not uniformly positive ones. Subthemes here included students' anxiety about losing technical/procedural skills during the rotation and, notably, persistent difficulty understanding the mental health nurse's professional role even after direct clinical exposure.

For nurse educators, the most actionable finding is arguably the third theme's second subtheme: exposure through clinical placement did not, by itself, resolve students' confusion about the mental health nurse's scope of practice. This suggests that clinical hours alone are an insufficient lever; how faculty frame the specialty, structure debriefing, and integrate mental health content alongside medical-surgical content may matter more than raw contact time. The compartmentalizing of illness into medical versus mental categories also points to a curricular opportunity: explicitly teaching the biopsychosocial continuum, rather than presenting mental health nursing as a discrete, bounded unit, may reduce the othering that appears to feed stigma.

As a dissertation, the study is bounded by its qualitative design and small, single-institution sample; findings describe the meanings 20 American BSN students made of their experience and should not be read as prevalence data or as generalizable across programs, provinces, or countries. Konzelman's use of Goffman's stigma theory gives the analysis a strong conceptual anchor, but readers should note that the abstract available through ERIC does not report verbatim participant quotations, effect sizes, or a detailed demographic breakdown of the sample, which limits independent appraisal of how the themes were derived. For Canadian nursing faculty, the study offers a useful discussion prompt: how do our own mental health rotations, clinical debriefs, and cross-disciplinary faculty conversations either reinforce or dismantle the medical/mental divide that this study identifies as a barrier to positive attitudes and clear professional identity formation in mental health nursing.