What this article is about
In brief
In this 2017 phenomenological dissertation, 20 BSN students at one southeastern Pennsylvania university described mostly unfavorable attitudes toward mental health nursing. Prior exposure, course content, faculty messages, and brief acute-care placements shaped those views; no participant chose the specialty because...
For nursing students
Study summary
Lois Konzelman’s 2017 doctoral dissertation examined how undergraduate nursing education shaped BSN students’ views of mental illness and mental health nursing. The study took place during a summer mental health course at a small, religiously sponsored university in southeastern Pennsylvania.
Konzelman used descriptive phenomenology and Colaizzi’s method to analyze one-to-one interviews with 20 students. Interviews occurred during the final week of the course, after the teaching content and clinical experiences had been completed. Goffman’s stigma theory provided the conceptual framework.
Students’ attitudes ranged from favorable to unfavorable, but the researcher characterized most as unfavorable. Prior experience mattered. Students who had worked with people receiving mental health care, or whose family members or friends had received such care, tended to describe more positive views. Students whose impressions came mainly from media portrayals often expressed more negative attitudes. The dissertation also reports that some non-psychiatric nursing instructors discouraged students from entering the specialty.
The course did not consistently correct these views. Some students continued to separate physical and mental illness rather than thinking holistically. Safety-focused teaching increased anxiety for several participants before clinical placement. Their placements were limited to locked units in acute-care hospitals or mental health facilities; none included community mental health centres, transitional living, or an Assertive Community Treatment team.
Clinical work and teaching activities often affected attitudes negatively for this group. Students worried that mental health nursing would reduce their technical skills, and some remained unclear about the mental health nurse’s role. None of the interviewed students decided to enter mental health nursing because of the rotation.
These findings describe the experiences of 20 students in one short summer course. They do not estimate how common these attitudes are across nursing programs. The dissertation is most useful for examining how course language, placement variety, faculty attitudes, and role clarity can influence students’ understanding of psychiatric-mental health nursing.
Original publication
Source abstract and study details
Read the source abstract
Historically, nurses have lacked recognition for the work they do, especially in the area of mental health. There is a shortage of qualified mental health nurses to meet the demand for services. Many rural areas in the United States have few or no mental health services to offer communities. Encouraging positive attitudes toward mental health nursing is an important step in the recruitment of new nurses into the specialty. This study used Colaizzi's method of phenomenology to explore the beliefs held by undergraduate BSN students towards mental health nursing and how undergraduate nursing education affected those attitudes. The purpose of the research was to understand undergraduate nursing students' attitudes toward mental health, to understand the impact that content and clinical experiences and experiences with non-mental health faculty have on attitudes toward mental health nursing, and to understand how undergraduate nursing education can contribute to the de-stigmatization of mental health nursing. Guided by Goffman's (1963) stigma theory, 20 participants were interviewed. Data analysis revealed three major themes: a) student nurses had varied attitudes toward mental health nursing, b) students had varied understanding of mental illness and mental health nursing at the end of the course rotation and c) clinical experiences and teaching strategies produced attitudinal changes in undergraduate nursing students. The two subthemes extracted from the first theme were students attitudes ranged from favorable to unfavorable and attitudes were based on experience and exposure to mental illness and mental health nursing. Subthemes from the second theme included students did not comprehend content as presented and they compartmentalized illnesses as medical or mental. Subthemes from the third theme included students had concerns over loss of technical skills and they did not comprehend the role of the mental health nurse even after clinical experiences.
Reviewed findings
Main findings
- Participants’ attitudes ranged from favorable to unfavorable, but the researcher characterized them as mostly unfavorable.
- Prior work or personal contact with mental health care was associated with more favorable accounts, while media-based exposure often accompanied more negative views.
- Course content sometimes increased fear and reinforced a separation between physical and mental illness rather than correcting it.
- Brief, acute-care-focused placements left some students uncertain about the mental health nurse’s role; none chose the specialty because of the rotation.
For teaching and learning
Education implications
- The author recommends placements across community, primary, acute, outpatient, recovery, and rehabilitation settings so students see more than locked-unit care.
- Safety teaching should avoid implying that aggression is unique to people with mental illness; the dissertation recommends connecting safety principles to all clinical settings.
- Programs should review faculty language, placement length, role preparation, and the balance between lecture and active learning when evaluating how the curriculum addresses stigma.
For educators
Teaching and appraisal notes
Konzelman used descriptive phenomenology to investigate how mental health course content, faculty communication, and clinical experiences influenced 20 BSN students. Interviews were conducted in the final week of a compressed summer course at a small university in southeastern Pennsylvania. Analysis followed Colaizzi’s method and was framed by Goffman’s stigma theory.
The study’s most consequential result was not simply that attitudes varied. The researcher concluded that attitudes were mostly unfavorable and that the educational experience often failed to improve them. Safety content contributed to fear and anxiety; students continued to divide mental and physical illness; acute-care placements offered little view of community or recovery-oriented practice; and some students interpreted the specialty as a threat to technical skill development. No participant selected mental health nursing because of the rotation.
The dissertation recommends clinical experiences spanning primary care, crisis care, outpatient treatment, recovery, and rehabilitation. It also recommends reviewing how safety is framed, using active learning rather than relying chiefly on lecture, examining whether theory and clinical rotations receive sufficient time, and addressing stigmatizing messages from psychiatric and non-psychiatric faculty.
The study included several credibility practices: the researcher collected data outside her own workplace, kept a reflexive journal to bracket assumptions, used open-ended interviews, and returned findings to participants for confirmation. Its transferability remains limited by the single-site, 20-participant sample and the short summer course. Faculty should therefore use the findings to audit local curriculum and placement design, not as prevalence estimates for nursing students generally.
Critical appraisal
Limitations
- The study involved 20 students at one small, religiously sponsored university in southeastern Pennsylvania.
- Participants completed a brief summer mental health course, so the compressed teaching and placement schedule may have shaped their experiences.
- The phenomenological interviews describe this group’s meanings and perceptions; they do not measure attitude prevalence or establish that the course caused the reported views.
Classroom use
Discussion Questions
- How might placing every student in a locked acute-care setting shape what they believe mental health nurses do?
- Which parts of safety teaching are necessary preparation, and which forms of wording could unintentionally connect mental illness with danger?
- How could a program show that therapeutic, assessment, communication, and technical nursing skills belong to the same professional role?
- What messages about psychiatric-mental health nursing do students receive from faculty outside the specialty?
Source-based questions
Frequently asked questions
Why were many students’ attitudes toward mental health nursing unfavorable?
The interviews linked attitudes to prior personal or work experience, media portrayals, faculty messages, course content, and what students encountered during the rotation. The design identifies patterns in participants’ accounts; it does not rank the influence of each factor.
Did the rotation encourage participants to choose mental health nursing?
No participant reported deciding to enter the specialty because of the rotation. Some described moving from possible interest or ambivalence to rejecting it.