We’ve seen the statistics showing that nurses and future nurses need mental well-being more than ever.
With healthcare staffing shortages all over the country, healthcare facilities and consumers cannot afford to lose more nurses. At the root of it is that nursing is an incredibly stressful profession, with 63% of nurses reporting significant workplace stress, 70% saying they put the safety and well-being of the patient above their own, and 31% reporting a workload assignment higher than which they felt comfortable (American Nurses Association, 2021).
In addition, 29% of nurses reported feeling sad, down, or depressed for two weeks before the pandemic, with an increase to 34% during the pandemic (American Nurses Association, 2021).
So how do educators ensure future nurses don’t enter the workforce without the skills to cope with the demands of the job? Modeling support for students in nursing school is the start for future nurses to learn resilience through the challenges of school so that they can manage the stress throughout their nursing career.
Nursing school is a demanding career path and one of the most challenging programs. Students enter the field from diverse backgrounds and often with many personal struggles – from academic challenges, medical conditions, strenuous family responsibilities, mental health challenges, and even prior traumas.
In addition, many students worked through the pandemic assisting nurses who were helping to save lives while experiencing high levels of stress and depression.
When faculty understand and agree that nursing students are experiencing stress and mental health issues, this is the time to provide support and model how to endure these challenges for long-term success. To give students the instruction they need to care for patients holistically, Chamberlain University established the Chamberlain CARE® model.
Educating Students on Mental Health
My career goal has been to combat the stigma of mental illness. The Chamberlain CARE® model has further inspired me to support students through nursing school to become strong and compassionate nurses. As a faculty of mental health nursing, it is crucial to educate students on mental health because every patient and family member they meet will likely experience some form of anxiety.
When patients and families come in, they often deal with a long list of emotions – from apprehension about a diagnosis, severity of the condition, recommended treatment, long-term implications, and even future medical bills. When experiencing this anxiety, the patients and families may display uncharacteristic behaviors as they try to cope with an unpredictable and stressful situation.
It is important to remember the feelings of fear and anxiety people have when seeking healthcare services, as these can be their most vulnerable moments. As nurses, we are in hospitals routinely and become comfortable with the environment. However, we are generally not the ones dealing with an illness or injury and facing uncertainties. Therefore, all nurses must interact with patients compassionately and without judgment.
When teaching mental health, we connect the students to a true understanding of the individual in crisis to develop greater compassion and empathy. We are in a unique position because there is greater subjectivity involved. Diagnosing and treating mental illness involves creating trust with the patient so they feel comfortable disclosing their deepest thoughts, fears, and feelings.
As educators, our role is to provide delicate guidance to help connect the students’ emotions to the reality of the patient’s trauma and life horrors. Without this connection, the students will more likely display stigmatizing behavior that prevents patients from seeking and complying with treatment.
Mental illness is a critical issue, and stigma infects societal attitudes. Many need mental health services but never seek treatment due to that stigma. As a result, some patients can accept their diagnosis, while others grapple with the idea of being seen from a vulnerable and stigmatized perspective. In healthcare, everyone is perceived as caring and compassionate, but empathy toward those with mental health issues is lacking.
This prevents follow-through on appropriate treatment and services and exacerbates the mental health issues, potentially leading to further development of mental illness diagnoses. Interventions to combat stigma are critical to the stability of these individuals and society.
Everyone Has Bias
If we confront the preconceptions nursing students may have, we can help reduce the stigma toward individuals with mental illness throughout all areas of healthcare. The first point to recognize is that everyone has bias.
We all have certain beliefs about people or groups formed throughout childhood and other experiences. Some biases we have are not even rational. Some thoughts jump into our heads, but then we may even realize that we do not believe or support those thoughts. The most important part is acknowledging that we have these thoughts. Without acknowledgment, we allow our behaviors to support those biases. For example, common biases toward mental illness are that these individuals are more aggressive or do not take care of themselves. If a nurse has these thoughts about a patient and does not acknowledge them, that nurse is likely to judge and stigmatize.
Deconstructing the Stigma
Before delving into mental illness diagnoses, we have a class discussion about stigma. We discuss what it is, where it comes from, and how it impacts everyone involved. We examine cases of some of the worst traumatic experiences and how the surviving individuals will struggle for the rest of their lives no matter the other circumstances of their lives. From that understanding, we can recognize that any one of us is a moment away from the potential of a similar life-changing tragedy.
One of the key points to remember is that those without a mental illness diagnosis are not so different from those with a diagnosis. Many patients we help in an inpatient behavioral health setting have a history of trauma, hence the greater insistence on more mainstream trauma-informed care. In the current healthcare environment, it is becoming increasingly common for nurses to experience trauma through violent events and the workplace’s compounding stress.
Impactful Self-Assessment Activity
One of the other activities the class participates in is a self-assessment using the Adverse Childhood Experiences (ACEs) scale. Ten traumatic experience categories are tallied to determine an ACEs score. The range is from zero to 10 in the scoring of traumatic childhood experiences. Once the students confidentially calculate their scores, I have them anonymously enter them into a poll that presents the class scores on the screen for everyone to see.
It is an incredibly impactful experience for the students to see the scores of their classmates. Through discussion, we realize how many students in that class have experienced high levels of trauma, primarily as they reflect on the description of each question. Some realize they are not alone in their traumatic childhoods while also, at times recognizing for the first time that those experiences are not typical for a child to experience.
This has become one of the most important activities I have implemented. It causes the students to recognize that they do not even know their classmates well enough, so how would they be able to understand their patients well enough to justify judging them? As we reflect on the numbers, I emphasize to the students that none deserved any of those traumas, just as none of our patients deserve the traumas that destabilized their mental well-being.
Support is often the most critical factor in overcoming and enduring trauma, mental illness, and life challenges. Throughout the course, there is a continual emphasis on self-care and coping skills for teaching others and as a resource for themselves. We know what nursing today looks like with nurses experiencing stress and trauma. Collectively reducing stigma can strengthen the mental health support and treatment we can provide, which can also help the nursing field. With a non-judgmental approach from healthcare professionals, we can better support each other in our times of need.
The impact of self-realization that my students experience drives me to continue supporting them. And notes from students like Larry Pitts, a senior at Chamberlain’s Addison campus who is finalizing his program, are my inspiration. “In 2020, I wasn’t doing the best in school. I was careless, unfocused, and unmotivated. Once I found my motivation and started doing better in school, Professor Mayo always made it her priority to acknowledge my progress and let me know I was doing a great job! She was a haven because she welcomed everyone to discuss anything without passing any judgment. I am forever thankful for her.”
- Centers for Disease Control and Prevention. (2020, April 3). Adverse Childhood Experiences (ACEs). Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/aces/index.html
- Compassion Fatigue Awareness Project. https://compassionfatigue.org
- American Nurses Association. (2021, October). Healthy Nurse, Healthy Nation Year Four Highlights 2020-2021. https://www.healthynursehealthynation.org/~4a9f4b/globalassets/hnhn-assets/all-images-view-with-media/about/hnhn-oct21-issue-921.pdf
- Kellogg, M. B. (2021). Secondary Traumatic Stress in Nursing. Advances in Nursing Science, 44(2), 157–170. https://doi.org/10.1097/ANS.0000000000000338