The State of Nursing Student Mental Health and Wellness Support as Perceived by Nursing Faculty: A Qualitative Study
Abstract
The primary aim of this study was to describe and understand how nursing faculty manage nursing students’ negative mental health wellness in the academic environment. A qualitative descriptive design was used. A purposive sample of 15 nursing faculty from 12 accredited undergraduate baccalaureate nursing programs across five states in the Eastern United States participated in semistructured interviews. Results revealed faculty conduct significantly impacts students’ psychological states. Detailed strategies to build resiliency skills and foster student belongingness and mental health wellness were also described. This unique consideration of supportive interventions for the plethora of student academic stressors offers nursing faculty a means to structure the learning experience to effectively assist students. Implications include providing faculty with a clearer understanding of behaviors, strategies, and resources for fostering student mental health wellness and nurturing resilience so they may better educate and evaluate students to ensure a healthy global future nurse workforce.
1. Introduction
Nursing curricula have been associated with psychological distress in nursing students. Rigorous programs of study, challenging examinations, and performance-based progression policies result in stress-related illnesses, depression, and sleep disturbances in nursing students [1, 2]. This negative mental health wellness can lead to delayed academic progress as well as physical and psychological problems continuing into their professional practice [1, 2]. Nursing faculty must have the knowledge to identify when symptoms are overwhelming, as well as provide the necessary support, before students experience unhealthy symptoms and academic failure [1].
2. Literature Review
Mental health wellness in nursing students must be a priority as psychological distress may affect students’ academic progression. In addition, nursing students must address their personal health to prevent burnout and flourish in the nursing profession. Manifestations of negative mental health wellness in nursing students are sometimes not apparent [3]. Research studies have identified several factors influencing psychological distress in nursing students, such as the academic environment (heavy course workload, frequency, and difficulty of examinations), and psychosocial stressors which include economic difficulties and family and relationship issues [2–4].
Recent studies support the important role of resilience in assisting nursing students to overcome difficult tasks and promote mental health wellness [5–7]. In addition, resilience-building and self-care and wellness strategies can mitigate student stress and anxiety that are consistently associated with nursing education [6, 7]. Recognizing essential resilience-building strategies and self-care behaviors to assist students is vital to lessen their psychological distress and promote effective learning and mental health wellness [1, 7]. Resilience can be fostered in academic environments that are nurturing, supportive, and uplifting [5].
Students’ sense of belongingness can influence their overall academic success as well as their physical and mental health and wellness [8]. Squire, Gonzalez, and Shayan [9] also stated that the university environment plays a significant role in fostering belongingness, which can lead to enhanced student learning. Competencies that foster a sense of belonging such as faculty support have been shown to contribute to resilience [7].
3. Theoretical Framework
Meleis’ [10] middle-range transitions’ theory provides the theoretical underpinning for this study. This theory describes the experience of individuals who are confronting and coping with a situation or a stage in growth and development that requires new skills and behaviors [10]. As the undergraduate nursing student is transitioning through a nursing program, there are stringent academic and emotional demands placed on these students, which can lead to negative mental health wellness. Meleis [10] proposes that nursing faculty can moderate student transitions.
4. Author’s Statement on Presuppositions and Bracketing
As the researcher conducting this study, I acknowledge the significance of recognizing and accounting for my own presuppositions and prior experiences to ensure objectivity in examining faculty support for nursing student mental health wellness. Over the course of my career, I have seen various ways faculty members engage in student mental health wellness initiatives, which has led me to believe that their support is essential for creating a healthy campus environment. In addition, I have observed that while some faculty feel well-equipped to effectively assist students, others may not have a clear understanding of resources and strategies for fostering student mental health wellness. As I began this research, I made a deliberate effort to set aside these preconceptions and personal experiences. This process of bracketing involved reflecting on and distancing myself from my assumptions to prevent them from shaping the data collection and analysis.
5. Research Questions
Despite the abundance of research on nursing students’ psychological distress, there is a paucity of research appraising the manifestations of negative mental health wellness and actions to support nursing students’ mental health wellness, as perceived by the nursing faculty.
- 1.
What are nursing faculty perceptions of negative mental health wellness among nursing students in the academic environment?
- 2.
How do nursing faculty manage negative mental health wellness among undergraduate baccalaureate nursing students in the academic environment?
6. Methods
6.1. Sample and Data Collection
This study used a qualitative descriptive design and was approved by the institutional review board at the author’s university. A purposive sample of 15 full-time nursing faculty with a minimum of two years of nursing faculty experience from 12 generic, accredited, undergraduate baccalaureate nursing programs in public and private universities across five states in the Eastern United States was recruited via electronic mail invitation. The researcher used screening questions to ensure participant eligibility. Inclusion criteria required nursing faculty to have at least 4 semesters of teaching experience in accredited, generic baccalaureate nursing programs in the Eastern United States, a minimum of a master’s degree in nursing, and to have taught in the academic setting within the past academic year. Exclusion criteria included nursing faculty with fewer than 4 semesters of teaching experience and those who have not taught in the educational setting within the past academic year.
Eligible faculty participated in open-ended, in-person, interviews. A semistructured interview guide (Supporting) was used during interview sessions to direct questions and minimize the introduction of biases [11]. The interviews extended from 28 to 52 min and occurred over a four-month span. Sample size adequacy was justified by the researcher when the saturation of data was achieved. Saturation was decided when no new information was discovered, feedback was repetitious, and previously collected data were reinforced. Participant ages ranged from 42 to 70 years, with nursing faculty experience extending 5–30 years (Table 1).
| N/mean | % | Range | |
|---|---|---|---|
| Gender | |||
| Female | 12 | 80 | |
| Male | 3 | 20 | |
| Race/ethnicity | |||
| Black/non-Hispanic | 2 | 13 | |
| White/non-Hispanic | 9 | 60 | |
| Asian/Pacific Islander | 2 | 13 | |
| Hispanic | 1 | 6 | |
| Middle Eastern/North African | 1 | 6 | |
| Age in years | 56.7 | 42–70 | |
| Years of work experience as nursing faculty | 14.1 | 5–30 | |
| Level of student taught in academia | |||
| Freshman | 1 | 6 | |
| Sophomore | 1 | 6 | |
| Junior | 4 | 27 | |
| Senior | 9 | 60 | |
| Certification as a nurse educator | |||
| Yes | 4 | 27 | |
| No | 11 | 73 |
6.2. Data Analysis
Colaizzi’s [12] method directed the data analysis. An extensive data appraisal began with coding chunks of information after preliminary interview summarization. The researcher conducted open coding autonomously, focusing on the main objective of the study, and analyzed the data thoroughly, reviewing it word-by-word and line-by-line to identify key categories and processes [11]. The researcher analyzed the data to identify recurring phrases, emotions, beliefs, experiences, and values and started to uncover common themes and patterns. Data collection and analysis ran concurrently, until it was determined, in consultation with a peer reviewer, that data saturation had been reached [11].
Data were comprehensively examined to find repeated patterns of meaning, leading to the recognition of themes. Interview data were reviewed by both the researcher and the peer reviewer independently and then further clarified through consensus discussions. Once the initial themes were identified, the researcher reviewed the coded data again to ensure that they accurately represented the experiences of the participants. Some themes were refined or combined, while others were split into subthemes. e.g., the theme of fostering a favorable learning environment was further divided into subthemes related to teaching compassionately (e.g., varying instructional approaches and providing detailed syllabi) and advocating for the student (e.g., exhibiting sensitivity and kindness).
To ensure transparency and rigor in data analysis, field notes, observations, and procedural and personal reflections were incorporated into the data management process. During data analysis, the researcher consulted field notes, which provided additional insights into nursing faculty participants’ comments that were not apparent from the interview data alone. The researcher also practiced reflexivity by maintaining a reflective journal, documenting personal thoughts, feelings, and any potential biases that could have influenced the study’s findings during data collection [11]. To enhance data trustworthiness, member checking was performed throughout the interview process, an audit trail was maintained to document study decisions, and multiple reviews of audio recordings were conducted to ensure the consistency of the interview process.
7. Results
Study results are summarized in Table 2. Several themes and subthemes emerged from the interview data. The major theme that surfaced with respect to the first research question was struggling with the teaching–learning process. Overall, participants expressed that many students are stressed and anxious in the academic environment. Faculty described student behaviors such as crying, tardiness, absenteeism, anger, and emotional outbursts as actions that could be indicative of students’ negative mental health wellness in the academic environment. Participants conveyed that many students are overwhelmed, exhausted, and unable to manage the rigorous course load in nursing curricula.
| Theme | Subtheme | Description | Example quote |
|---|---|---|---|
| 1. Struggling with the teaching–learning process | 1.1. Grappling with personal life factors | Challenges nursing students encounter outside of school that impact their academic success such as personal relationships, health problems, grief, and financial difficulties | One of my students was in an abusive relationship, she was living out of her car and sleeping on friends’ couches |
| 1.2. Enduring uncivil interactions | Poor interactions with peers, healthcare staff, and faculty play a role in worsening students’ mental health wellness | While coteaching with a colleague, a student approached the desk with a question. The faculty member visibly rolled her eyes and responded with “you should know that”. The student appeared as though she were on the verge of tears | |
| 2. Fostering a favorable learning environment | 2.1. Teaching compassionately | Faculty demonstrate teaching methods that promote engagement and open communication in the classroom | “One size doesn’t fit all” when it comes to teaching techniques in the classroom, we must diversify how we present the information, otherwise some students are confused and frustrated, and their stress levels go through the roof! |
| 2.2. Advocating for the student | Participants conveyed faculty actions and behaviors that support students’ mental health wellness | Recognize and validate students′ emotions to make them feel heard and supported. Try to connect with students on a personal level, not just academically. Take time to check in with them and ask how they’re really doing. It’s not always about business; it’s about building relationships | |
Failing a test will throw some students over the edge, they cry and cry. Getting any kind of negative feedback will cause some students to get angry or have an emotional outburst. I think some students just don’t seem to know how to effectively cope with negative situations.
I had a student in class who was not submitting assignments. I come to find out this student was in an abusive relationship and could not return home. She was living out of her car, sleeping on friends’ couches, and did not have reliable internet. She was depressed and had to withdraw from the semester. This experience changed the way I approach students who don’t turn in assignments, it always makes me think something more serious may be going on with a student.
Enduring uncivil interactions was the other subtheme that emerged from the data. Participants described negative interactions with peers and healthcare staff in the clinical environment as contributing to negative nursing student mental health wellness in the academic environment. However, some participants expressed that negative interactions with faculty were the main contributors to students’ negative mental health wellness. Participants described faculty behaviors such as insensitivity, not listening, not being approachable, inflexibility, poor communication, rigidity, being demanding, and having unrealistic expectations as contributing to negative mental health wellness in nursing students.
We as nurse educators must be open and approachable to our students. If an educator is rigid or demanding in their demeanor, this will significantly add to student distress. Students must feel they can come to us when they have a problem, be able to trust us. If they don’t feel comfortable approaching us, who can they go to? We need to be role models for caring and understanding -that’s the nature of the nursing profession.”
Fostering a favorable learning environment was the overarching theme that emerged from the second research question. This theme is comprised of nursing faculty teaching practices, actions and behaviors, and strategies and resources provided to students to create and maintain the most desirable and satisfactory learning conditions to promote nursing students’ mental health wellness and resilience in the academic setting. In addition to fostering relationships and modeling appropriate behaviors in the classroom, approaches such as a gratitude jar, stress-reduction strategies, self-care and wellness programs, and cultivating belongingness were deemed instrumental by participants to support students’ psychological wellness. In addition, faculty expressed the importance of connecting students with mental health resources. Two subthemes that surfaced from the data were teaching compassionately and advocating for the student.
Teaching compassionately represented teaching practices that foster connection and communication in the classroom. Participants expressed faculty practices such as distributing detailed syllabi, providing clear directions and expectations, presenting information clearly, and varying teaching approaches to meet students’ needs.
“One size doesn’t fit all” when it comes to teaching techniques in the classroom. Because we have a diverse group of learners, we must diversify how we present the information, otherwise some students are confused and frustrated, and their stress levels go through the roof!
Advocating for the student illustrated faculty behaviors and actions that support students’ mental health wellness. Participants expressed faculty behaviors such as being flexible and approachable, listening, exhibiting empathy and kindness, and utilizing professional communication as suitable to facilitate satisfactory student learning conditions.
Sometimes faculty are not cognizant of “what they say and how they say it” to students. Words matter! Some faculty add additional stress to students who are already stressed out to the max by their negative words and tone.
We can’t control personal stressors a student faces outside the classroom-but we can control our demeanor towards students. I’m not going to tell a student they don’t have to submit a particular assignment, but most times just being available to listen to their struggles- “being human” is tremendously supportive to them.
Sometimes faculty have “tunnel vision” in the classroom. We must be a role model for caring, not just focus on our agenda for that class but be there for students and take the time to check in with them.
8. Discussion
Participants in this study provided descriptions of how negative mental health wellness may be manifested in nursing students. Furthermore, various strategies were presented by study participants to support students’ mental health wellness in the academic environment. Study themes and subthemes suggest that the approach to student support is multifaceted. In the subtheme of enduring uncivil interactions, participants from this diverse group emphasized the significant role that nursing faculty behavior plays in negatively affecting students’ psychological well-being.. According to transitions’ theory, faculty can facilitate successful transitions by providing support and assistance and functioning as role models [10]. It is worth considering that some educators may not intentionally engage in dismissive behaviors or may be unaware that their actions and behavior are perceived as such. However, faculty must recognize how their interpersonal interactions with students can help or hinder the learning process. This may require ongoing self-examination and reflection on how their behaviors and approaches influence student engagement.
The theme fostering a favorable learning environment focused on the teaching practices, behaviors, and actions of nursing faculty, as well as the strategies and resources they offer to students, all designed to create and sustain an optimal learning environment that promotes nursing students’ mental health wellness and resilience within the academic context. Participants emphasized that nurse educators are well-positioned to address this mental health dilemma by implementing relevant classroom instructional techniques. Stress-reduction and resilience-building strategies and instruction should be incorporated by faculty in the nursing curriculum to promote positive student mental health outcomes [13]. While it is impossible to eliminate all workplace stressors, educators can emphasize interpersonal protective factors and guide student preparation to assist them in overcoming future challenges associated with professional practice [6]. Preparing students to persevere through adversities is a practice-ready competency that is preparatory to success throughout their careers. Strategies to build resilience may also include mindfulness-based stress-reduction strategies, muscle relaxation and meditation exercises, self-care, communication skills, problem-solving skills, study skills, life coaching, and peer support training [2, 4, 14], which can be implemented by way of homework assignments, reflective journaling, roleplaying, experience sharing, or lectures [2].
Techniques such as a wellness wheel, a gratitude jar, yoga, and self-care resources were indicated by participants for nurturing resilience and mental health wellness. The wellness wheel is a free resource used to promote resilience and self-care/well-being. This visual tool is comprised of seven factors (emotional, intellectual, physical, social, environmental, financial, and spiritual) that affect mental health [15]. This resource can prompt introspection and self-reflection and lead to goal setting [16]. The practice of keeping a gratitude jar assists students to be more mindful and appreciative by reflecting on positive aspects of their lives which can support mental health wellness [17].
Teaching compassionately embodies practices that nurture connection and facilitate communication within the classroom. Participants conveyed that adapting teaching methods to address the diverse needs of students plays a crucial role in influencing students’ mental health wellness. While it is impossible to eliminate all psychological distress, faculty can take relatively simple and manageable actions that are greatly appreciated by students and can help reduce their distress, such as setting clear and realistic expectations, providing effective study guides, and knowing if students understand what is being taught [18].
Advocating for the student includes psychologically supportive faculty behaviors. Study participants identified creating a caring environment as essential for supporting nursing students in managing their mental health challenges. Li et al, [19] also expressed the importance of faculty caring behaviors in mitigating student psychological distress. In addition, Stubin et al. [7] emphasized faculty caring behaviors such as being supportive, encouraging, and patient, and demonstrating kindness, compassion, and respect as substantial predictors of decreased psychological distress in nursing students.
Fostering a sense of belongingness emerged from most participant interview data as integral to supporting students’ mental health wellness in the academic environment. Strategies aimed at fostering a stronger sense of belonging within the university community and enhancing major-specific satisfaction among nursing students are critical [20]. Faculty participants expressed the necessity of promoting social networks and connectedness through student organizations such as the Student Nurses Association and peer support initiatives. Important resources for supporting student belonging and creating a positive classroom culture include helping students feel appreciated, striving to understand students, and trying to improve rapport with students [17]. Similarly, Frangieh et al. [21] suggested nursing programs facilitate extracurricular activities and peer relationships to boost a strong learning community, which can influence students’ educational success as well as their physical and mental health and wellness.
Nursing faculty need to be the “eyes and ears” in the classroom to be alert for the sometimes-subtle manifestations of students’ mental health deterioration and have the knowledge to equip resources for at-risk students. Faculty should be offered regular development workshops focusing on recognizing signs and symptoms of possible student psychological distress, how to respond appropriately, and awareness of resources for referral [22]. Participants relayed that many universities’ mental health resources are inadequate. As agents of change, nursing faculty must advocate for increased on-campus and community resources to support students’ mental health wellness. Nursing-targeted interventions to address mental health concerns, as well as improved on-and-off campus services, will assist in ensuring healthy student psychological states [1].
9. Limitations
The small sample size in this study may limit the generalizability of findings to a larger population. In addition, distinctive aspects of a particular program or university culture may have shaped nurse educator participants’ viewpoints.
10. Conclusion
Despite study limitations, this unique consideration of supportive interventions for the plethora of student academic stressors offers nursing faculty a means to structure the learning experience to assist students more effectively. Study results revealed faculty descriptions of manifestations of negative mental health wellness in nursing students, as well as rich, detailed, and in-depth descriptions of strategies to build resiliency skills, foster belongingness, and positively contribute to mental health wellness in nursing students. The themes and subthemes that emerged from the interview data can benefit the nursing profession by assisting both novice and seasoned academic nursing faculty to improve nursing education practices.
A resilient future nurse workforce begins with the active mentoring and preparation of students by faculty. Incorporating supportive faculty actions and behaviors, self-care practices, wellness strategies, and resilience training throughout the nursing curriculum promotes positive educational outcomes and can facilitate a smoother transition for students into professional nursing practice. This approach helps build a strong foundation for better stress management contributing to longer, more fulfilling, careers in nursing, subsequently strengthening the global pipeline of mentally and physically healthy and resilient nurses.
Conflicts of Interest
The authors declare no conflicts of interest.
Funding
The research was supported by Rutgers, The State University of New Jersey.
Supporting Information
An interview guide with a semistructured format (Supporting) was utilized during the sessions to steer the questions and reduce potential biases.
Open Research
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
