Core Competencies in Psychiatric Mental Health Nursing for Undergraduate Nursing Education - Position Paper 2009
THIS DOCUMENT HAS BEEN PREPARED BY THE EDUCATION COMMITTEE OF THE CFMHN
By: P. Tognazzini (BC), C. Davis (ON), A.M. Kean (NL), P. Tognazzini (BC), C. Davis (ON), A.M. Kean (NL), M. Osborne (AB), K. Wong (ON)
Introduction
The future of psychiatric - mental health (PMH) nursing lies in the preparation of new graduate nurses who will meet the mental health care needs of society. In Canada, one in five people suffer from a mental illness (Canadian Collaborative Mental Health Initiative, 2006). The World Health Organization (2008) predicts that by 2020 depression will be the leading cause of disability second only to heart disease. Mental illness is also a contributor to mortality rates. The Crisis Intervention and Suicide Prevention Centre of British Columbia states that suicide is the second leading cause of death among youth 15 to 24 years of age (2008). Stigma towards persons with mental health problems and mental illnesses has persisted throughout history. Nursing students are not immune to societal perceptions and discrimination towards this population. Although as a nation we have become more tolerant, negative beliefs and attitudes among health care providers towards persons with mental health problems and mental illnesses still exist (Standing Senate Committee on Social Affairs Science and Technology, 2006). This emphasizes the need for significant enhancement of PMH nursing in undergraduate curricula.
There is a significant percentage of the Canadian population that do not receive the treatment and care they need for mental health problems and mental illnesses. Access to mental health services is an ongoing concern as the mental health system continually struggles with limited resources. Nurses will encounter persons with mental health problems and mental illnesses in all areas of health care such as the person with depression after heart surgery or families with a member exhibiting signs of a drug induced psychosis or a person suffering from a crisis with post-traumatic stress symptoms. How will these new graduate nurses be able to advocate for persons with mental health problems and mental illnesses if they have not had PMH nursing exposure through their undergraduate nursing program? “In order to practice holistically, nurses need knowledge of and experience with psychiatric mental health nursing issues” (Chan, Buchanan, Forchuk, Moore, & Wessell, 1998). The Canadian Federation of Mental Health Nurses (CFMHN), an affiliate of the Canadian Nurses Association (CNA), has as one of its major foci the quality and quantity of undergraduate PMH nursing theory and practice in Canadian schools of nursing. In 1998, the CFMHN education committee developed a position paper (Chan, uchanan, Forchuk, Moore, & Wessell, 1998) which responded to major curriculum concerns. It reported that some generic undergraduate nursing programs do not require nursing students to have theory or clinical experience in PMH nursing.
Background
In 2006, in preparation for a review and revision of the 1998 position statement, the current CFMHN education committee conducted a national environmental scan of undergraduate nursing programs in Canada. Thirty schools of nursing responded to our questionnaire that asked if a stand alone course in PMH nursing was included and if this course also required clinical experience in a PMH setting. The participating schools of nursing were also asked about the number of hours of clinical practice and the number of hours of theory in PMH nursing in their respective programs.
Results of the scan indicated that 20% of the schools of nursing that participated did not offer a stand alone course in PMH nursing and did not offer any clinical experience in this area. Some schools of nursing stated that PMH nursing theory was “threaded” throughout the curriculum. Of the 80% of the schools of nursing that offered a stand alone course, the number of hours of theory and the number of hours of clinical practice in a PMH setting varied greatly. The hours of theory ranged from 1.5 to 7.5 hours a week for 12 weeks with the mean being three hours a week for that duration of time. The number of hours of clinical experience in a PMH setting varied from 25 to 330 hours over a 12 week period with a mean of nine hours a week. The clinical settings included inpatient psychiatric units in general hospitals and psychiatric hospitals as well as outpatient and day programs. Some schools also offered community experience at mental health and assertive case management teams.
Studies exploring nursing students’ attitudes and beliefs prior to clinical experiences in PMH nursing indicate that there is fear that persons with a mental illness are dangerous (Happell, 1999). Clinical experience was identified as the most important determinant in changing these fears and in gaining a more favourable view of this area of nursing (Happell, 2008; Rushworth and Happell, 2000). Nurses who graduate without any clinical experience in PMH nursing state that they have insufficient knowledge, skills and confidence in intervening with persons who have mental health problems and mental illnesses. Research conducted in urban areas has found that many nurses are unprepared to support the mental health needs of persons with mental health problems and mental illnesses (Brinn, 2000). How can schools of nursing ethically graduate nursing students who have little or no knowledge of caring for 20% of the Canadian population who experience a mental illness? If there is no exposure to the lives and suffering of persons and families with mental health problems and mental illnesses, are we as educators perpetuating societal stigma?
The CFMHN have anecdotally received reports from employers that new graduate nurses are unable to perform the basic skill of a mental status examination and lack fundamental PMH nursing knowledge upon graduation. This supports the literature in emphasizing that clinical experience is highly influential on the extent to which
nursing students are able to acquire the desired knowledge, skills and attitudes to care for persons with mental health problems and mental illnesses (Martin & Happell, 2001; Mullen & Murray, 2002). Exposure to formal PMH treatment settings can motivate nursing students to seek both preceptorships and further preparation for employment in this specialized area of practice after graduation.
Click here to download the complete Position Paper (Sept 21 2009)
