Sparking Interest

Internship Gives Students Window into Psychiatric Nursing

The current deficit of psychiatric nurses is alarming. We look to nursing schools to help meet this need, but many do not offer specific training in caring for patients with psychiatric needs. As a result, new nurses are not prepared to care for these patients. Many have had no guided interactions with this population and others have had minimal exposure. The typical nursing curriculum is hard pressed to include the ever-growing volume of nursing knowledge. However, increasing numbers of patients with behavioral health needs indicate that new nurses should be equipped to care for this population. Recognizing this as an opportunity, an academic internship in behavioral health was created during the fall of 2018 at the University of Kansas Health System, Kansas City, with the first internship taking place in January 2019. This internship provides the student nurse training in caring for this patient population through active learning experiences and clinical interactions with patients and their caregivers.

Caring for patients with behavioral health needs is happening in inpatient hospitals, ambulatory clinics and psychiatric hospitals. The numbers of patients with psychiatric comorbidities is rising. To help meet the increasing demand, our health system has increased its bed capacity for both adult and pediatric patients with acute behavioral health needs, thus increasing the demand for behavioral health nurses. The academic internship in behavioral health is a collaboration among content experts, academic partners, health care leaders, educators and clinical staff providing an intensive learning experience (See Figure 1). Nursing students are invited through their school to participate in either a two-week winter break program or a four-week summer program. The school agrees to provide academic credit and faculty oversight during the program, allowing students to participate under the affiliation agreement already in place and meeting criteria for clinical participation. Through an application process, students who have an interest in behavioral health are identified.

The goals of the internship are clear: to increase empathy for the patient with behavioral health needs, to decrease the stigma associated with caring for these patients and to increase the overall understanding of the care provided to these patients. The health system used a variety of methods to achieve these objectives. Three simulated activities are included. The first is a hearing voices simulation (Deegan, 2020) completed after a presentation by our psychologist on schizophrenia, hallucinations and delusions. Each intern listened to voices similar to what one would hear with schizophrenia, while performing activities such as walking to a café, completing a job application or filling in a word puzzle, followed by a debriefing session. Another activity, called Walk in Her Shoes, helped interns learn about the experience of a victim of domestic violence trying to get help. Interns make choices to ask for help and then follow the path to where those choices take them. In addition, didactic sessions on power and control, trauma-informed care and suicide prevention further inform the intern about how health care providers support and help patients who have experienced trauma. The third simulated experience involves choosing two movies depicting situations involving mental health and writing a reflection of the impact media has on our understanding of mental illness.

Each of these experiences, when combined with presentations and guided clinical observations, helped the interns understand and empathize with patients. This program, using interactive and didactic learning combined with clinical observations, allows the interns to come away meeting the program’s goals. The following are comments from the interns: “This internship changed the trajectory of my life,” “I love the diversity of [psychiatric nursing] and how unique it is, compared to other nursing areas,” and “Everyone deserves to be heard.” The interns have empathized and reflected, and many have decided to care for these patients. To date, the health system has hired 11 of the 16 participants from our first two cohorts. Two of these interns are continuing their pursuit of knowledge in this area by completing immersion experiences within the organization’s behavioral health units. The students and their schools have been very satisfied with the internship experience.

To further identify if the program met its goals, the Mental Illness Clinician’s Attitude Scale v. 2 (MICA-2) was used to measure changes in attitudes as a result of this program (Gabbidon, 2013). While the numbers are still small, the assessment showed an increase in 13 of the 16 items. The changes seen in the MICA-2 demonstrated an increase in valuing the role of the psychiatric nurse and other caregivers. The interns were more willing to learn about mental health. Interns believed more strongly that primary care providers should fully assess patients with psychiatric symptoms, and not merely attribute pain and other symptoms to mental illness. These responses demonstrated a deeper understanding of the holistic needs of the patient.

During each internship, instructors provide time to discuss with the students what they have learned. Students have shared how the information they received has made them more aware of mental health in general as an important part of nursing care. They said the program, including presentations in the classroom and clinical experiences, made a huge impact in helping them bring their new knowledge into the practice setting. The interns described seeing these behavioral health patients as simply people with an illness who needed care through comments such as, “I know that this will make a difference in how I look at each patient,” and “This internship was one of the most valuable learning opportunities I have had throughout my schooling. Whether you are going into behavioral health or not, the information provided during this course can be taken to any area of the hospital or even your personal life.”

These comments and the MICA-2 results showed the internship successfully decreased the stigma related to the patient with a psychiatric diagnosis and the nurse providing psychiatric care. It also has increased the student’s understanding and empathy for these patients. As a result, the pipeline of new nurses wanting to work in psychiatric and behavioral health nursing is growing at our organization. After presenting this program at several venues in the fall of 2019, a need across the country was identified for more training on mental health. As a result, we have begun planning how we can share this program with others.

About the Author

References

Deegan, P. (2020). Hearing Voices curriculum. National Empowerment Center. Retrieved from https://power2u.org/store/hearing-voices-curriculum/

Gabbidon, J., Clement, S., van Nieuwenhuizen, A., Kassam, A., Brohan, E., Norman, I., & Thornicroft, G. (2013). Mental Illness: Clinicians’ Attitudes (MICA) Scale—Psychometric properties of a version for healthcare students and professionals. Psychiatry Research, 206(1), 81-87.