Integrating Mental Health Nursing in the Undergraduate Nursing Curriculum

Teaching nursing students how to care for clients with mental health problems has been a part of nursing education programs for years. Although research has consistently shown that mental health is not a preferred area for a desired career, several studies have demonstrated that didactic preparation and clinical experiences positively influence students’ attitudes toward mental health nursing (Happell & Gaskins, 2012). However, changes in the mental healthcare system (including decreased inpatient beds and funding cuts for mental healthcare in the US) created challenges for schools of nursing. With a decrease in inpatient mental health facilities (Lutterman, Shaw, Fisher, & Manderscheid, 2017), nursing schools lost clinical sites for students’ learning opportunities. In addition, the role of the RN in these settings has become more administrative, so students do not have the opportunity to have RN role models to learn how to care for mental health clients. Furthermore, mental health clients are found in every healthcare setting, not just inpatient facilities (Loveland, 2016; Barry & Ward, 2017). Students cared for mental health clients in maternity units, oncology units, pediatrics, and the intensive care.

In order to meet the needs of clients in all areas of healthcare, students must learn about mental health concepts throughout the nursing programs. Teaching mental health concepts across nursing curricula will more appropriately prepare students for caring for the mental health needs of clients from all populations and developmental levels.

In preparation for integrating Mental Health concepts and content throughout the curriculum, the faculty examined key documents such as the Baccalaureate Essentials (American Association of Colleges of Nursing, 2008) and NCLEX-RN Test Plan (National Council State Boards of Nursing, 2018) to identify included mental health components. Also, faculty reviewed previous NCLEX results in the areas of mental health and mental illness. The faculty who taught the Mental Health course developed a detailed curricular map of how content could be distributed across the lifespan, on a wellness to illness continuum, and across multiple care settings. Pertinent mental health objectives were added to all clinical courses. In addition, mental health components were also added to each clinical evaluation and in the nursing care plan templates used in each course. Expert guest lectures, simulations, case studies, inpatient and outpatient clinical activities were all utilized to ensure content and concepts was covered.

Summative feedback from students collected through end of program surveys and focus groups from two cohorts of ABSN students indicated a lack of awareness of what mental health concepts were covered and how mental health had been threaded throughout the curriculum. The students perceived that this material has not been covered adequately. Students often failed to recognize concepts as part of mental health, such as therapeutic communication or stress because they were taught in concert with other concepts. The faculty did not explicitly name each concept as mental health. T-test scores demonstrated no significant difference in NCLEX pass rates or ATI scores in eight cohorts, approximately 560 students.

Going forward, we will continue regular review this content to ensure that it is retained in the curriculum and work with content experts to explore ways to consistently embed concepts. Concepts will be placed strategically within the program to enhance student learning and solidify knowledge acquisition. The course faculty will be more direct in labeling mental health content and concepts when they are being presented in the curriculum and are looking to develop a standard icon or symbol that can be incorporated into course lectures to be a visual reminder to students. In addition, faculty across courses will reiterate learned concepts and build on them from one semester to the next.