Exploring the accounts of mental health student nurses’ first practice placement: how can they be more fully prepared?

Abstract

This research study, part of my Doctorate of Professional Practice (DProf), aimed to explore the accounts of mental health student nurses’ first mental health practice placements to identify how they could be more fully prepared prior to placement. The research also aimed to inform the practice development stage of this Professional Doctorate. My literature review identified a paucity of research concerning mental health student nurses and the first mental health practice placement. However, I found a wealth of literature exploring adult student nurses and their placements. These placements were from a variety of nursing health care settings, including mental health. Mental Health and Adult Nursing students describing a less positive experience said they felt anxious, were not made to feel welcome or wanted, and did not feel adequately prepared for placement. They were also aware they had missed out on valuable learning compared to those who felt more confident, better prepared and wanted. I was curious to find out what the experience was for mental health student nurses and whether there was more I could do, in my education role, to help prepare these students. My research took the form of a two-phase qualitative study. Phase one of the studying the gene5ic model comprised four focus groups with 26 mental health student nurses to explore the expectations of mental health student nurses prior to the first mental health placement. Phase two of the study took the form of a narrative inquiry and used a diary interview method to collect the same students’ accounts of their practice placement. Post-placement, four of the same students took part in in-depth face-to-face interviews and their diaries provided the cues for the interviews. I subjected the transcripts from the four focus groups to thematic analysis using Braun and Clarke’s (2013) seven stages of coding. The accounts from the diary: diary interviews were analysed using narrative analysis. The scripts were firstly scrutinised and in alignment with structural analysis, stories were created according to Labov and Waletsky’s (1967) analytical model of six structural clauses framework. The stories were then explored to identify the structure of the stories and, a further level of analysis explored how each of the students positioned themselves during their placement. From the four focus groups it was found that the students were unsure about what to expect from placement. They were concerned that they might see something that they did not want to, that they might not be able to adjust into their role as students and get on with their mentor. Amongst the uncertainty, the students were expecting to change and develop and were looking forward to having opportunities and to learning something new. The findings from the students’ positions in the second phase of the study suggested that those four mental health student nurses processed forwards and backwards through seven different stages before successfully completing their placement as more confident student nurses. These stages are that a) it might not feel welcoming, b) some things might seem puzzling, c) be a seeker of opportunities, d) show you are worthy, e) be prepared to be annoyed, f) be prepared to be surprised and g) expect things to have changed. The overall finding was that the students’ appeared to have positioned in response to interactions with placement staff and when the interactions were negative, the students positioned backwards to earlier stages. When the interactions were positive, the students positioned forwards to more confident stages. From the findings of the study, a collection of five different interactive and collaborative activities and games were developed, with the aim of helping mental health student nurses prepare for their first practice placement. These activities mainly focussed on what students might expect to encounter on their first placement in response to interactions with staff and the seven different stages. A sixth activity was also developed in response to the sharing of information that took place between the students during each of the focus groups. My doctoral research indicates that if mental health student nurses were prepared to expect some negative interactions with placement staff and were guided in how to manage these, they would enter placement more fully prepared to make the most of the learning opportunities available.