Consistently ranked as the most trusted health professionals, nurses play a unique role in identifying mental health issues. So it’s important that nursing programs focus on both the physical and mental needs of patients to provide better care, nurse educators say.
“Today’s nurse is trained to be a leader on the health team,” says Patricia Chute, dean of the New York Institute of Technology School of Health Professions. “As a leader, student nurses need to be able to assess not only the physical manifestations of any patient, but also the effects that the disease may have on their mental health.”
Institutions of higher education that educate nurses—as well as other health specialties—have a responsibility to focus on both kinds of patient needs, Chute says.
Scope of Mental Health Illness
The sheer number of patients dealing with mental health illness warrants the need for student nurses to learn how to identify, assess, and treat such conditions as well as know when to seek someone with more expertise. Approximately 1 in 5 adults in the U.S.—or 43.8 million— experience mental illness in a given year, according to the National Institute of Mental Health.
Mental illness often develops when a person is young, and if left untreated, robs him or her of more years of healthy life than any other disease, experts say.
About 90% of suicides are related to mental illness.
“With the state of mental health in America, we desperately need a cadre of health professionals, and in particular nurses, who are able to identify, assess, and treat patients with mental health needs,” says Bridgette M. Brawner, PhD, APRN, assistant professor of nursing in the Department of Family & Community Health at the University of Pennsylvania School of Nursing.
“Mental health is an increasing concern and we are seeing mental health in every clinical setting we do,” says Margaret D. Pharris, PhD, RN, CNE, FAAN, professor and associate dean for nursing in the Henrietta Schmoll School of Health at St. Catherine University in St. Paul and Minneapolis, Minnesota.
The prevalence of mental illness fuels why “it is important to teach students that everyone exists on a continuum from optimal mental health to mental illness,” says Judith L. Evans, DNP, RN, director of nursing at Concorde Career Institute in Orlando, Florida. “Either a small or a major change in the patient, their family, or environment may affect his or her mental health to a certain degree.”
It is best to look at nursing as a dynamic and integrated discipline that requires schools of nursing to promote an understanding that mental health can affect physical health and, conversely, physical health can affect mental health, she says.
“Nursing has been described as both an art and a science. What must be delivered to nursing students is how this translates into practice by seeing the patient in a holistic manner and providing care that addresses all the needs of the patient,” Evans says.
Exposure to a variety of settings, including clinics, mental health hospitals, and psychiatric nursing therapy groups, where patients share their stories, benefit student nurses, educators say.
“We take our students into the mental units in area hospitals where it’s really helpful for them to see people in an exasperated state,” Pharris says.
Student nurses at St. Catherine University also learn how to hone the communication skills needed to identify mental illness in other ways, including during staged scenarios. For example, they work with a preceptor who plays the role of a depressed, elderly man. Students must conduct a suicide assessment on him in a sensitive manner, she says.
For Penn Nursing students, the classroom is the safest space for students to troubleshoot, brainstorm, and develop the communication skills needed to perform mental assessments.
“When they have to ‘think on their feet’ to implement the skills they’ve learned in lectures, they are better prepared to handle complex clinical scenarios,” says Brawner.
Students encounter actors who role play clients in need of mental health assessment and treatment. In addition, case-based learning presents students with information based on factual cases from the faculty’s clinical practice. Students work together to determine the appropriate nursing assessment and intervention to meet the patients’ needs.
“As a result of these opportunities, our students develop skills in critical thinking, reflective judgment and care team collaboration as they process real-life scenarios with faculty guidance,” says Brawner.
Penn Nursing students also learn the negative affects of untreated mental illness and the importance of seeing psychiatric-mental health as a critical component of all areas of nursing practice, and in all settings.
“Whether one intends to work in neonatal intensive care, or build community capacity in Guatemala, psychiatric-mental health assessment and intervention is essential to nursing practice regardless of where we work,” says Brawner.
Penn Nursing advocates the screening of all patients, regardless of appearance, with appropriate referrals as needed. “Sometimes our unconscious biases can cause us to assume that certain people are ‘ok’ and do not have mental health concerns, but everyone deserves to be assessed to maintain their health and wellness,” Brawner says.
Penn Nursing partners with Philadelphia’s Department of Behavioral Health to get students trained in ‘Mental Health First Aid’ by local clinicians so they learn how to recognize and intervene in crisis. Additionally, students are trained in motivational interviewing for mental health concerns and other behavioral issues.
At New York Institute of Technology, the nursing program utilizes a holistic transcultural approach that teaches students to carefully ask and listen to their patients. “These types of behaviors are infused into every course to ensure that the future nurse will have a toolkit of clinical competence that results in the best patient outcomes,” says Chute.
“The use of standardized patients, actors who are trained to perform as patients, along with laboratory simulations provide students at NYIT with experiences that are invaluable in identifying potential mental health issues. Dr. Lisa Sparacino, the coordinator of the simulation lab at NYIT, provides opportunities for students to learn the art of listening as well as that of asking questions,’’ she says.
Evans agrees that nursing students must learn how to ask the necessary open-ended questions that allow them to gather data for a physical and mental assessment of a patient.
“This comes through initial knowledge and is perfected with much practice,” she says. “It is also important that students see this modeled in their instructors. Instructors need to listen and not just hear what the students are saying. When a student realizes this difference, they will be able to ask the pertinent questions.”
In building a relationship with a patient, a nurse student must learn how to be aware of both stated and unstated needs to ensure the patient receives appropriate care, nurse educators say.
What is one of the best ways for nursing students to practice the art of listening? “Listen with the whole body and be completely present in the situation…. to provide the care that is needed,” says Pharris.
Meeting Diverse Needs
To increase awareness of the diversity in the cultural and spiritual needs of patients, educators stress the importance of infusing a transcultural approach into courses and clinical rotations. To best prepare nurses to address mental illness in patients, students must be given opportunities to explore different cultures and how each addresses or reacts to illness, childbirth, and death. This approach can enlighten students and help them provide more holistic care, nursing experts say.
A dedicated course in holistic transcultural nursing is a good starting platform, says Evans. “However, it is important that the concept is integrated into each nursing course. Nurses provide care to a diverse population of patients with varying mental and physical problems across the lifespan on a daily basis.”
Pharris agrees. St. Catherine University nursing students are connected with various cultures because mental health is perceived differently in different cultures. “So we try to honor cultural variations. We are right now forming a new baccalaureate program that will be transcultural and holistic as a framework… with traditional healers and shamans and medicine people and African American traditional healers.
“We will look at ‘what does mental health look like from the various perspectives?’ And then, ‘how do we connect within communities and educate practitioners from those communities?’ so that every nurse that graduates from this institution has this proverbial black bag at her or his side with all of the healing modalities from western medicine to traditional medicine,” Pharris says.
The goal is to equip nurses so that they can listen to the patients and their family to find out what health needs they have and know exactly what tools to take out of their black bag to best address their illness, Pharris says.
Patients tend to place more trust in people directly caring for them, which is why nurses consistently top the Gallup survey that ranks professions on ethics and honesty, nurse educators say.
Nurses, whose responsibilities include health promotion, health maintenance, and assistance in disease treatment, serve at the front lines of health care, says Pharris. That’s why mental health education is crucial for nurses at the pre-licensure and graduate level, she adds.
“We are at the side of the patients, so it is important to know that person, and know the full range spectrum of mental health issues, and know how to respond to what may be helpful and help people negotiate what they want in that setting.”