The Attitude and Perception of Nursing Students Toward Psychiatric Nursing: Pre- and Postclinical Experience—A Qualitative Study Using Diary-Interview Methods
Abstract
Background: Numerous studies have explored how psychiatric nursing practice enhances students’ experiences, but none have simultaneously examined their pre- and postpsychiatric practice. Experiential clinical practice allows undergraduates to reflect on theoretical knowledge, bridging theory and practice.
Aim: The purpose of this study is to explore the pre- and postpsychiatric experience of selected nursing undergraduate students in Saudi Arabia.
Design: A qualitative diary-interview method was conducted on nursing students.
Methods: The data were collected through the diary-interview method with nursing students undertaking psychiatric courses and were analyzed using the thematic analysis method.
Results: Four main themes emerged from the study’s diary reflections: nursing students’ feelings toward psychiatric nursing (emotions), nursing students’ perceptions about caring for people with mental, illnesses (opinions), remarkable experience during clinical experiences, and pre- and postclinical experience (comparison). In addition, three main themes emerged from the study’s interviews: psychiatric nursing clinical placement experience (situation and experience) and easing the stigma toward mental illnesses and people with mental health problems (opinions and stigma).
Conclusion: One of the most demanding clinical settings that nursing students encounter is psychiatric nursing. Preparing students for preclinical exposure is one of the most crucial strategies to reduce their stress. This can be accomplished by creating various scenarios that mimic real-world events and connecting theoretical lecture themes with lab simulations. Staff educators can also direct students toward competent skills and help them become self-aware.
1. Introduction
Numerous studies have explored, examined, and measured the impact of nursing students’ psychiatric practicum on their experience. However, none have simultaneously investigated both pre- and postpsychiatric practice experiences. Experiential clinical practice enables undergraduates to reflect on theoretical knowledge, bridging theory with practical application.
The psychiatric clinical experience constitutes an integral component of nursing students’ educational programs, diverging from the more task-oriented nature of theoretical contexts [1]. While clinical practice is foundational in nursing education, students may find it challenging due to perceived deficiencies in practical skills [2]. Contrarily, some argue that students actively contribute to shaping their constructive clinical experiences [3]. In addition, scholarly perspectives highlight that effective communication and collaboration among psychiatric nursing students enhance practicum outcomes and alleviate anxiety associated with the experience [1]. Consequently, students’ performance and confidence are expected to see improvement.
2. Background
Psychiatric nursing students may demonstrate both positive and negative attitudes toward their practicum [4]. While negative experiences can arise from anxiety and stress linked to the stigmatization of psychiatric patients, there are also positive aspects that facilitate improvements. A study in Saudi Arabia demonstrates that preclinical exposure preparation assists nursing students by simulating real encounters with psychiatric patients, linking theory with practice in a stress-reduced environment [5]. This approach creates conditions that mirror real-world situations, offering a safe and effective educational environment before the actual practicum. Negative attitudes among psychiatric nursing students or healthcare professionals may pose challenges in managing patients with psychological illness, leading to a lack of support and effective communication with patients [6].
Psychiatric nursing students need a foundation in key principles of skillful communication with psychiatric patients, providing patient-focused care with cultural sensitivity [7]. A study disclosed this need to concern that psychiatry, psychiatrists, and psychiatric patients are often judged based on public prejudices and false stereotypes. Psychiatric nursing students are not immune to these social biases, influencing their attitudes toward their practicum. These attitudes significantly impact the type and outcomes of care provided to mentally ill patients during the practicum [7]. Students may initially share stereotypical views that psychiatric patients are unpredictable, prone to violence, and less responsive to medical advice. Such stigmatized attitudes are crucial, especially given the lower rate of seeking medical advice for mental disorders during youth, a critical period for predictable mental health issues [7]. Stigma among healthcare providers, including nursing students, remains a significant barrier to progress in psychiatric patient development [6]. Recognizing the dual nature of attitudes, both negative and positive, among psychiatric nursing students, it becomes evident that preclinical preparedness helps them respond more seriously yet less stressfully to real situations [5]. This underscores the importance of revising teaching strategies and enhancing psychiatric health education programs [7] to reduce the stigma associated with psychiatric illnesses, thereby mitigating negative attitudes during preclinical practicum.
Although there are some psychiatric nursing students who have negative attitudes toward their practicum, there are students who have a positive attitude regarding their experiences [7]. A study shows that the positive attitudes toward mental health in nursing educational programs contribute to the retention of the nurses in the field [8]. They also claim that the exposure to theoretical and clinical experience in psychiatric nursing impacts the attitudes toward psychiatric patients constructively. Another study emphasizes on the fact that the final-year nursing students who study psychiatric nursing courses under more positive attitudes toward mental diagnosis and psychiatric patients perceive and empathize with the role they are expected to demonstrate at the end of their courses, yet they do not want to pursue their future jobs in psychiatric clinics because they believe that they do not observe and accept the psychiatric nursing during practicum. On the other hand, a study suggests that nursing students are more likely to adopt positive attitudes toward psychiatric patients more than medical students [9]. They prove to be more benevolent. He evaluates his assumptions through using the Attitude Scale for Mental Illness. Most notably, psychiatric nursing students who complete psychiatric courses demonstrate a positive impact on improving positive relations with psychiatric patients compared to students who do not enroll in psychiatric courses. They demonstrate a significant change toward the stereotype associated with psychiatric patients.
An additional study underscores that students are better prepared to care for patients with mental health concerns when exposed to mental health nursing through clinical experiences, theory studies, and prior work in the field [10]. Another study emphasizes the essential role of both theory and practice in nursing education and the development of a professional identity for students. While problem-based learning cultivates transferable skills for therapeutic settings, clinical experiences and mentors take precedence in this process [11].
The findings across these studies underscore the variability in attitudes among psychiatric nursing students, influenced by factors such as the depth of theoretical knowledge, adaptability to challenges, guided preclinical preparedness, and the practicum environment. While anxiety is a common thread affecting attitudes, certain studies highlight the positive aspects of the experience, revealing a mixed attitude among psychiatric nursing students toward mentally ill patients. The necessity for revising teaching methods and modifying nursing programs is evident, emphasizing the need to destigmatize psychiatric health assessment. The collective findings provide insights for promoting more positive attitudes in psychiatric nursing students after their practicum. Ultimately, this study aims to inspire further investigations into the pre- and postattitudes of psychiatric nursing students in Saudi Arabia.
2.1. Statement of the Problem
Numerous studies have explored how psychiatric nursing practice impacts students, but few studies have examined both pre- and postexperiences. Yet, no study has provided simultaneous insight into both their pre- and postpsychiatric practice experiences. Experiential clinical practice offers undergraduate nursing students the opportunity to reflect on their theoretical knowledge, thereby bringing it into practice. This study explores the pre- and postpsychiatric experiences of selected nursing undergraduates in Saudi Arabia.
3. The Study
3.1. Aim
The purpose of this study is to explore the pre- and postpsychiatric experience of selected nursing undergraduate students in Saudi Arabia.
3.2. Objectives
- 1.
Compare the attitudes of nursing students who are undertaking psychiatric courses from prereflections (diary) with their postreflections (diary).
- 2.
Compare the perception of nursing students who are undertaking psychiatric courses from prereflections (diary) with their postreflections (diary).
- 3.
Explore nursing students’ emotions toward caring for psychiatric people.
- 4.
Identify the obstacles that the nursing students may face when caring for people with psychiatric illnesses.
- 5.
Investigate the experiences of nursing students using follow-up interviews.
3.3. Research Question
What are nursing students’ attitudes and perceptions toward psychiatric nursing?
4. Methodology
4.1. Research Design
A qualitative diary-interview method was used to accomplish this study’s aim and objectives. It is a qualitative method that involves participants keeping a record of their experiences, which are routine records of participants’ experiences that could capture rich data on individual events, beliefs, and/or feelings [12].
4.2. Research Setting
The research setting was King Abdulaziz University’s nursing students who are enrolled in nursing bachelor programs in both cities of Jeddah and Rabigh.
4.3. Sampling and Sample Size
A sample of approximately 17 nursing students was recruited for this study according to the inclusion and exclusion criteria.
The inclusion criteria for this study involve fourth-year nursing students at King Abdulaziz University who are currently enrolled in the psychiatric course. To be eligible for participation, students must complete both a pre- and postreflective diary during their clinical placement. On the other hand, exclusion criteria encompass nursing students who are not currently enrolled in the psychiatric course. In addition, those who have not submitted both pre- and postreflective diaries on their clinical placement experiences are excluded from participation.
4.4. Data Collection Procedure
The data were collected through reflections, diary-interviews with nursing students undertaking psychiatric courses.
4.5. Recruitment Process
Following ethical approval that was obtained from the Ethical Committee of the Faculty of Applied Medical Sciences in Rabigh, a convenient sample consisting of fourth-year nursing students enrolled in the Mental and Mental Health course at King Abdulaziz University in Jeddah and Rabigh were engaged for this study (IRB# KAU/FAMS-R/23-002). Once the purpose of the research was thoroughly explained and approved by the students, data collection involved pre- and postdiary reflections as well as online interviews (refer to Appendix A for the tool and interview schedule). Written informed consent was obtained from all participants prior to their involvement in the study, ensuring confidentiality and voluntary participation. The total sample comprised 17 comprehensive pre- and postdiary reflections from female and male students in Jeddah and only female students from Rabigh. Subsequently, in-person and/or Zoom interviews were conducted for a representative sample from each category, totaling six participants. The participants were informed about the research team, interview schedule, and given the option to choose a suitable time. Each interview lasted not more than 30 min, was recorded for accuracy, and maintained confidentiality of information.
5. Results
5.1. Data Analysis
The data were analyzed using Braun and Clarke’s [13] thematic analysis method. This method consists of six stages as follows: familiarizing oneself with the data, generating initial codes, searching for themes, reviewing themes, defining, and naming, and finally generating the report.
5.2. Ethical Consideration
Ethical approval was granted from the Ethical Committee of the Faculty of Applied Medical Sciences in Rabigh, King Abdulaziz University for conducting the research. Participants were informed that the participation is completely voluntary, and they have the right to withdraw at any time they want.
5.3. Participants Information
A total of 12 pre-and postdiaries were included in this study. Among these diaries, seven were female nursing students (two from the Jeddah campus and five from Rabigh) and five were male from the Jeddah campus. Five follow-up interviews were conducted, two females from Jeddah and three females from Rabigh.
5.4. Diary Findings
5.4.1. Theme 1: Nursing Students’ Feelings Toward Psychiatric Nursing (Emotions)
Nursing students’ emotions and attitudes toward psychiatric practicum exhibit a spectrum of responses shaped by their unique experiences. The gathered data unveil a dynamic journey, capturing the distinct phases of their emotional evolution, before, during, and after clinical practice. A predominant sentiment among students prior to commencing their psychiatric clinical practicum is one of fear and uncertainty, with a notable minority expressing excitement about the impending experience.
The ensuing statements encapsulate genuine responses from nursing students as they anticipate their clinical practice: “very excited” (DRF_1); “I thought they would be in an aggressive mood, and they would attack us” (DJM_4); “I feel a little nervous and confused. I was feeling pressured about what I was supposed to do, but at the same time, I feel confident and courageous to know the story of the patients and communicate with them” (DJF_1); “afraid of seeing patients and the probability of them attacking me” (DRF_11), “scary” (DJF_3), and “mixed feelings” (DRF_13).
As the psychiatric clinical practicum unfolds, students undergo a transformative process, becoming notably more self-assured and less stressed about their training. This transformation is marked by improved communication skills. However, lingering anxiety persists for a few students in anticipation of encounters with psychiatric patients. This unease is articulated in statements such as “At the end of the day, I realized that I was dramatic and the situation was not that bad” (DRF_12). Another student shared, “My anxiety was slightly relieved, thinking about the rotation” (DRF_14). Conversely, a positive experience was noted by another student who expressed, “The caregiver team was nice to the patient, making me feel happy and relaxed” (DJM_2). Nonetheless, some students conveyed discomfort, with one mentioning, “Their looks made me uncomfortable” (DRF_8).
In the culmination of their clinical practicum, nursing students exhibit a heightened awareness of their roles and responsibilities. This newfound awareness is accompanied by increased knowledge and engagement with patients, signifying a transition from initial fear to responsible practice. The following statements illuminate this significant shift in attitudes: “I feel more knowledgeable about nursing care in psychiatry” (DRF_15). A student added, “It was an unforgettable experience” (DJM_10). Another stated, “The feeling of fear was gone” (DRF_20). One remarked, “It was my favorite clinical rotation in my educational journey” (DRF_22), and another added, “I enjoyed visiting patients to talk to them and get to know them as well” (DJM_12).
In conclusion, the emotional trajectory of nursing students throughout their psychiatric practicum underscores a spectrum of initial apprehension evolving into heightened confidence, reflective engagement, and a profound sense of fulfillment, shaping their professional identity and fostering positive attitudes toward psychiatric care.
5.4.2. Theme 2: Nursing Students’ Perceptions About Caring for People With Mental Illnesses (Opinions)
This theme encapsulates the diverse opinions expressed by nursing students who completed the psychiatric nursing course, shedding light on their perceptions of the overall clinical experience. Participants offered nuanced insights into their views on different hospitals, with one student describing their time at the Addiction Hospital as “excellent” (DRF_2), while another compared hospitals, stating, “In my opinion, I really found the two hospitals on the second day were better than the psychiatric hospital” (DJM_3). A prevailing sentiment among most students was a collective agreement on the subpar quality of the mental health hospital environment: “The environment in the mental health hospital was really low quality” (DRF_4).
Furthermore, students delved into their observations regarding the welcoming nature of both staff and patients. One participant remarked, “The staff were helpful with us, but I didn’t like their way of dealing with patients” (DJM_7). Another student expressed a positive perspective, stating, “I found that everything is beautiful, and the patients welcome us and the nurses as well” (DJF_1).
In conclusion, nursing students’ diverse opinions on their psychiatric clinical experience provide valuable insights into their perceptions of different hospitals and the interactions with staff and patients, offering a multifaceted understanding of their journey in the psychiatric nursing course.
5.4.3. Theme 3: Remarkable Experience During Clinical Experiences
This theme unfolds through the narratives within students’ diaries, documenting distinctive experiences at the commencement and conclusion of their clinical journey. Some students recount positive, impactful encounters that left a lasting impression on them. Participants expressed gratitude for the warm reception from patients, the insightful orientation to the ward, and the overall helpful and cooperative atmosphere. The consensus among students is that the welcoming gestures from patients not only induced comfort but also served as catalysts, fostering rapid learning and enabling them to fulfill their expected roles. One participant shared a heartening incident where they, along with colleagues, surprised patients in the psychiatric hospital ward with traditional Saudi food (Masoub and Arika), chips, and biscuits. The patients’ joy was palpable, and the gesture even prompted one patient to present a flower to their instructor, symbolizing appreciation for the entire group, an endearing moment encapsulated in the participant’s exclamation, “It was the cutest thing ever” (DRF_1).
Conversely, some participants detailed challenges and distinctive experiences that they believe significantly influenced them. Spending more time on the ward and gaining clearer insights into psychiatric nursing skills, one participant faced a situation where a nurse instructed them to give each patient one cigarette after vital signs. A patient, however, insisted on having more, displaying aggression. The student adeptly managed the situation by calming the patient and reminding them about the hospital policy, ultimately reaching an understanding (DJM_1). Another student emphasized a challenging scenario when conversing with an irritable patient who suddenly became angry. Recognizing that dealing with such situations requires experience, the student acknowledged the possibility of handling the matter better in the future (DJM_2). This theme, thus, captures a diverse array of remarkable experiences, ranging from heartwarming interactions to insightful challenges, all contributing to the multifaceted landscape of psychiatric nursing.
In conclusion, the theme of remarkable experiences during clinical encounters among nursing students unfolds as a tapestry of diverse encounters, from heartwarming gestures to insightful challenges, collectively shaping their journey in psychiatric nursing.
5.4.4. Theme 4: Pre- and Postclinical Experience (Comparison)
This theme emerges from the diaries of students who completed the psychiatric nursing course, detailing their initial challenges and subsequent growth. Most students eagerly anticipated the clinical experience as novel and challenging. One participant expressed, “This experience that I was waiting for since the second year” (DJM_4), while another foresaw “more psychological challenges” (DJM_2). A student, despite initial fear, held on during their first exposure to mental illnesses, stating, “When we went to the male ward, I was about to cry, but I held myself and kept breathing” (DRF_2).
Students consistently reported a reduction in anxiety as their training progressed, becoming more adept in communication skills essential for psychiatric nursing. Exposure to patients allowed them to understand and build therapeutic relationships. Participants noted, “I started to be able to deal with different patients” (DJM_6), and another shared, “I was able to reach their trust, speak, listen to them, and try to understand them” (DJM_7). Some students highlighted the pleasant experience, emphasizing the significance of communication skills in helping patients.
Furthermore, participants detailed learning various skills related to medication, treatment, and mental illness. They gained insights into types, causes, treatment methods, and proper patient interaction. One student mentioned, “We learned about the types, causes, methods of treatment, and how to deal with patients” (DRF_5), while another learned “how it is done and what medications are needed with this treatment” (DJM_8).
Students also discussed correcting misinformation and changing their perspectives. One participant shared, “This experience was completely new and gave me a different view of nursing care in psychiatric and mental health” (DRF_11). Another highlighted attending ECT sessions and dispelling misconceptions, stating, “I corrected the concept about this treatment, not as the movies showed” (DJM_14). The clinical experience left a lasting impression, with students describing it as satisfying, unique, and unforgettable. A student expressed, “The clinical training was so interesting, and I learned a lot of things in my real life” (DJM_15).
In conclusion, the theme captures the transformative journey of nursing students through their pre- and postclinical experiences in psychiatric nursing, showcasing their evolving perspectives, newfound skills, and overall satisfaction.
5.5. Interview Finding
5.5.1. Theme 1: Psychiatric Nursing Clinical Placement Experience (Situation and Experience)
This theme arises from interviews where students recounted impactful experiences and challenging situations during their psychiatric nursing clinical placement. Initially, most students admitted to having little to no knowledge about mental health, including mental illnesses, treatment methods, and medications. One participant expressed, “Before we attended the course and studied it, my knowledge was zero about mental health in general” (IRF_1).
Many students identified fear and inadequate preparation as obstacles to learning and applying their knowledge during the clinical experience. One student stated, “Fear was the case. There wasn’t proper psychological preparation for us regarding the experience. For the first couple of days, most students were afraid to deal with patients; they might say something wrong and such” (IRF_4).
However, over time, students reported a gradual decrease in fear and anxiety, a change in their perspective on mental illness, and a significant improvement in their communication skills. One participant mentioned, “After I took the course, I started to understand their situation better, and my fear decreased significantly compared to the period before starting the course” (IJF_6). Another highlighted, “I think my communication is what has improved the most” (IRF_19).
All students acknowledged the development of their knowledge about medications, treatment methods, and how to interact with patients with mental illnesses. A participant expressed satisfaction, stating, “I am happy that I got to learn about ECT and acquire useful information about it” (IJF_17).
Some students recalled situations that triggered fear, anxiety, and curiosity simultaneously, such as facing an aggressive patient on their introductory day. Others shared attempts to communicate with aggressive patients, with varying degrees of success. One participant reflected, “I tried to talk with them calmly in a good way. It worked at times and failed at others” (IRF_2).
In conclusion, this theme encapsulates the transformative journey of students during their psychiatric nursing clinical placement, highlighting the initial challenges, the gradual overcoming of fears, and the development of essential skills in patient interaction and understanding.
5.5.2. Theme 2: Nursing Students Emotions Influencing Their Learning and Experience
As a matter of fact, the attitudes of nursing students simultaneously affect their motivation toward learning and psychiatric clinical practicum. In the following interview, the participants express the effects of their experiences on attitudes toward their learning. Most students express fear and anxiety before embarking on their training. However, these feelings have improved significantly after their actual training. Students are more inclined to express the positive impacts of their experiences, in terms of the acquired learning outcomes, increased awareness, and understanding of their vital role in the development of psychiatric patients. The following samples from the interview show the participants’ attitudes before and after their clinical practice.
Students’ attitudes before their practice: “I was so scared. I had many expectations in mind for how the hospital would be. What patients will I encounter? How to deal with them? It was all worrying and frightening” (IRF_1). A student said, “I feel like I get nervous and afraid” (IRF_2). Another added, “First, I had fears and didn’t know how to behave. Because of these fears, I even developed fears from the course material. My fears of how to deal with psychiatric patients planted fears inside me of the same material and the same course” (IJF_6).
Students’ attitudes after their practice: “I felt that the anxiety and fear I had before diminished on day one. I was so excited to come back the next day and deal with patients” (IRF_10). A student added, “I am very satisfied with it, and I benefited a lot” (IJF_8). Another added, “I feel that awareness of mental illnesses has increased significantly, and everything has changed compared to the past” (IJF_14). Also, another added, “I feel like what we had was a very formal type of communication. That was fine by me. I was very comfortable with it” (IRF_12).
In conclusion, nursing students’ evolving attitudes, transitioning from initial apprehension to enhanced confidence and understanding, underscore the transformative impact of their psychiatric clinical practicum on both their learning experiences and emotional well-being.
5.5.3. Theme 3: Easing the Stigma Toward Mental Illnesses and People With Mental Health Problems (Opinions and Stigma)
This theme crystallized from extensive interviews with students who completed the psychiatric nursing course, providing nuanced perspectives on their overall clinical experiences. Stigma, characterized by unfair societal beliefs, emerges as a central concern in their narratives. The students articulate their views on the training environment, with pointed criticisms of the psychiatric hospital’s unfavorable conditions. One student bluntly remarked, “The psychiatric hospital was so bad. The environment and the place where people live are unlivable” (IRF_2). Another participant emphasized, “I don’t feel that the hospital, as a place, is well-suited to fulfill its purpose to take care of psychiatric patients. I think if it were better equipped, it would be a whole lot better, even for patients’ mental health” (IJF_6). A revealing insight comes from a participant who noted, “The addiction hospital was normal; it was relatively better than the psychiatric hospital in terms of the environment and the things there” (IRF_10).
In a striking consensus, almost all students affirm that the staff treated them well, contrasting sharply with their observations of how patients were treated. One student expressed, “The staff treated students well, to be honest, and we learned from them. Some of them were good to the patients, while most of them treated the patients badly. They hit them for no reason, never listened to them, and kicked them out of a place” (IRF_5). Another added, “To be fair, they were so good to me. However, the way nurses dealt with patients was not likable to me” (IJF_7). Maintaining a positive note, a student reflected, “Good, if I have any question that needs an answer, they will respond and provide any help I need. That is a good thing, so, alhamdulillah.”
Furthermore, students delve into the societal impact on patients and their families, highlighting the pervasive stigma that impedes seeking medical help. “It deeply affects, regarding society or the way people treat patients, if that is what you meant. A lot of families have psychiatric patients or addicts that they cannot take to the hospital because of stigma. They are afraid that someone might learn about them and affect them” (IRF_6). Echoing this sentiment, a student emphasized, “I think it has a great impact. If I were a psychiatric patient, God forbid, I may not seek treatment due to society’s and people’s views on this matter. I think this problem has now diminished” (IJF_2). Another added a personal perspective, stating, “From my point of view, in our society, one with mental illness or symptoms fears seeking medical consultation. He is afraid of people’s judgment and words. Most people think that a person who goes to a psychiatric hospital is crazy. Immediately stereotyped as insane” (IRF_17).
In conclusion, the students’ candid reflections unveil a dual narrative of commendation for supportive staff and concern over suboptimal hospital conditions, interwoven with a poignant acknowledgment of society’s enduring stigma hindering those grappling with mental health issues, thereby underscoring the multifaceted challenges within the realm of psychiatric nursing.
6. Discussion
The main aim of the study was to investigate the attitudes of nursing students in the fourth year of their clinical experience, both pre- and postcompleting a mental and psychological health nursing course, using qualitative methods. Four main themes emerged from the study’s diary reflections: nursing students’ feelings toward psychiatric nursing (emotions), nursing students’ perceptions about caring for people with mental illnesses (opinions), remarkable experiences during clinical experiences, and pre- and postclinical experience (comparison). In addition, three main themes emerged from the study’s interviews: psychiatric nursing clinical placement experience (situation and experience) and easing the stigma toward mental illnesses and people with mental health problems (opinions and stigma). The participants discussed how their experiences affected their attitudes toward learning. Before starting their training, most pupils expressed worry and anxiety. However, following their actual training, these feelings significantly improved. Students are more likely to speak positively about their learning outcomes, greater awareness, and comprehension of their critical role in the development of psychiatric patients due to their experiences.
A study shows that positive attitudes toward mental health in nursing educational programs contribute to the retention of nurses in the field [8]. Another study’s findings emphasize the fact that the attitudes of psychiatric nursing students can be both negative and positive [7]. This study suggests that nursing students are more likely to adopt positive attitudes toward psychiatric patients more than medical students [9], proving to be more benevolent. They evaluate their assumptions using the Attitude Scale for Mental Illness.
Notably, psychiatric nursing students who complete psychiatric courses demonstrate a positive impact on improving relations with psychiatric patients compared to students who do not enroll in psychiatric courses. They exhibit a significant change toward the stereotypes associated with psychiatric patients. Nursing students reported that their anxiety reduced as their training and experience progressed. They became more familiar with the communication skills needed as psychiatric nurses. Students stated that the more they exposed and dealt with patients with mental illness, the more they were able to understand their patients and build a therapeutic relationship.
In addition, some participants explained that they learned different skills about medication, treatment, and types of mental illnesses. The students expressed a preference for taking the theoretical course before the clinical experience, which, in turn, made it easier for them to communicate with patients and reduced their level of fear and anxiety. A study highlights that the preclinical preparedness of psychiatric nursing students helps to simultaneously parody and predict real situations in which students can respond seriously yet less stressfully [5]. Many students expressed sympathy for patients unable to obtain treatment due to the stigma attached to psychiatric patients and psychiatry in general from society. The authors believe that one of the most significant impediments to progress in the development of psychiatric patients is the stigma among healthcare providers [6].
6.1. Limitation of the Study
The following limitations arose during the conduct of this study. First, since only one university was involved, the results cannot be generalized to the entire population of undergraduate students in Saudi Arabia. Consequently, if a different location and time period had been selected, the circumstances might have yielded different outcomes. Despite these limitations, the study is valuable for nursing schools as it aids in preparing students before they enter clinical settings.
6.2. What Did These Papers Add?
This study marks the inaugural attempt to evaluate nursing students’ attitudes and perceptions of pre- and postpsychiatric clinical experience in the western region of Saudi Arabia. The theoretical course provides students with a comprehensive understanding of mental illness; however, their perception, skills development, and reduction in fear manifest more prominently after gaining clinical experience.
7. Conclusion
Psychiatric nursing represents a notably challenging clinical milieu for nursing students. An imperative strategy to alleviate stress in this context is the careful preparation of students for preclinical exposure. This preparatory phase entails the creation of diverse scenarios emulating real-world events, coupled with the integration of theoretical lecture themes into laboratory simulations. Facilitators, in their role as educators, play a pivotal role in directing students toward the acquisition of competent skills and fostering self-awareness.
Moreover, empirical evidence underscores that students exhibit an enhanced perception of nursing in psychiatry and mental health subsequent to the theoretical coursework. Following the clinical experience, students manifest notable improvement in their ability to engage with patients, a reduction in fear and anxiety, augmentation of knowledge, and a heightened sense of empathy toward patients confronting barriers to medical access due to societal stigma. Notably, this transformative experience also exerts a discernible influence on students’ perspectives concerning future engagement in psychiatric nursing.
7.1. Implication for Nursing Practice
The findings underscore the importance of a comprehensive preparatory approach for nursing students, particularly in the domain of psychiatric nursing. Incorporating diverse scenarios mirroring real-world situations and integrating theoretical concepts into practical simulations emerge as a crucial strategy. Nurse educators play a pivotal role in guiding students toward acquiring competent skills and fostering self-awareness.
Practically, these implications suggest that nursing education programs should prioritize the development of preclinical exposure strategies tailored to the unique demands of psychiatric nursing. Facilitators should be equipped with effective teaching methodologies that bridge theoretical knowledge with practical scenarios, ensuring that students are well-prepared and confident when entering the challenging clinical setting of psychiatric nursing. This approach not only enhances the students′ skills but also contributes to a positive shift in their perceptions and attitudes toward mental health nursing, ultimately influencing their future engagement in the field [14].
Conflicts of Interest
The authors declare no conflicts of interest.
Author Contributions
All study authors contributed to the study.
Sara Yaghmour: research proposal, data analysis, writing and reviewing the manuscript, and supervision.
Amal Mohammedali Shami: literature review, data collection, entry and analysis, findings and discussion, and writing the manuscript.
Sheikah Abdullah Aljuhani: literature review, data collection, entry and analysis, findings and discussion, and writing the manuscript.
Sarah Shahhad Alnafei: literature review, data collection, entry and analysis, findings and discussion, and writing the manuscript.
Rawan Albeladi: literature review, data collection, entry and analysis, findings and discussion, and writing the manuscript.
Funding
No funding was received for this research.
Acknowledgments
We would like to express our deepest gratitude to everyone who contributed to the successful completion of this research. We also acknowledge the use of AI-assisted software, specifically OpenAI’s ChatGPT, which was utilized for language polishing during the manuscript preparation. However, all intellectual content, analysis, and conclusions remain the responsibility of the authors. In accordance with the ICMJE guidelines, all authors take full responsibility for the integrity and accuracy of the work as a whole.
Appendix A: The Tool/Interview Schedule
A1: Diary Reflection on the Clinical Placement Experience at Psychiatric Hospitals.
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Critically analyze your feelings and thoughts toward the experience.
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What did the experience mean to you?
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What went well and what went not so well (obstacles)?
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What are the next steps you will take?
- •
Critically analyze your feelings and thoughts toward the experience
- •
What did the experience mean to you?
- •
What went well and what went not so well (obstacles)?
- •
What are the next steps you will take?
- •
Describe at least one other action you could have taken (what would you do differently)?
- •
What was your summary “takeaway” message?
A.2: Interview About the Clinical Placement Experience at Psychiatric and Mental Health Hospital.
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How was your experience in the psychiatric department (positive or negative)? Tell us about it?
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How did you act in such situations, such as during the patient’s anger?
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Do you find yourself well-behaved in such situations?
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What strengthen your experience?
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How was your time spent with people with mental illnesses? Was it sufficient? What is the sufficient time?
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Based on your experience, what are the weaknessess of students during the course?
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What do you think about the hospitals you visited “Psychiatric and mental health hospital”?
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What are the similarities and differences between them?
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How was the staff with patients and the staff with you?
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How do you feel before visiting the mental health hospital?
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What is your feeling after your first day at a psychiatric hospital?
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What impact did the clinical experience have on you in the mental health hospital?
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How does mental health stigma affect people with mental illness, and how does it impact their ability to access care and support?
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How was your knowledge during clinical placement?
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What information was correct about mental illnesses? About people with mental illness?
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How was your ECT knowledge? Psychiatric drugs? Symptomatology?
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
