LIVED EXPERIENCES OF STUDENT-NURSES EXPOSED IN PSYCHIATRIC NURSING

ENVIRONMENTS: A QUALITATIVE STUDY

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An Undergraduate Research

Presented to the Faculty of the

BACHELOR OF SCIENCE IN NURSING
Pilar College of Zamboanga City, Inc.

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In Partial Fulfillment of the Requirements for the

Degree of Bachelor of Science in Nursing

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Researchers’ Name

JUMLAIL, AISA P.
ASTO, RODETTE EIRA A.
ITUM, MISHAEL R.
MICABALO, JULIANE M.
VENTURA, NICHOLAS XAVIER M.

Adviser’s Name

DR. JOMAR E. OCDENARIA

< October 7, 2023>

 CHAPTER 1

INTRODUCTION

Background of the Study

In recent years, psychiatric nurses experience increased levels of stress due to the

patient population they are caring for, which can include patients with suicidal ideation,

violent behavior, verbal, and physical threatening. This is often associated with more

emotional distress than other nursing specialty fields (Jacobowitz, 2019; Yoshizawa et al.,

2020). According to Amira Ali Alshowkan and Neama Mohamed Fouad Kamel (2019),

psychiatric mental health nursing is a specialized area of nursing practice, education, and

research that draws on unique knowledge from nursing and related health and social

sciences to update the practice and to establish its disciplinary boundaries. Psychiatric

nursing students are exposed to a variety of challenging situations during their training.

Research has shown that psychiatric nursing students are at increased risk for developing

stress, anxiety, depression, and post-traumatic stress disorder (PTSD). They are also more

likely to experience burnout and compassion fatigue.

In Iran (Tehran), Rahmani et al. (2021) found that psychiatric nursing students had

negative experiences during their training, including a lack of interest in working in

psychiatric wards due to severe stress, emotional burnout, and a negative public attitude

towards psychiatric nurses. They suggested the need to improve work conditions and

professional skills to increase interest in this field. In a Western Canadian province,

Chachula and Varley (2022) conducted interviews with psychiatric nursing students,

revealing power imbalances, abuse, and vulnerability in their experiences with faculty and
clinical counterparts. Emotional intelligence, self-efficacy, and resilience were identified as

essential for coping with potentially traumatic situations. In Jordan (2022), Abdallah Abu

Khait et al. explored the experiences of psychiatric nurses who had been assaulted in

inpatient psychiatric units. They emphasized the importance of preventive measures to

reduce workplace violence and provide ongoing psychological support for nurses dealing

with emotional and environmental challenges resulting from such incidents.

In the Philippines, a study conducted by Leodoro J. Labrague (2021) investigated

how the stress caused by the pandemic affected student nurses' well-being. The research

revealed that Filipino student nurses faced significant pandemic-related stress, but they

generally exhibited moderate to high levels of resilience, life satisfaction, and psychological

well-being. The study also found that increased stress due to the pandemic was linked to

lower life satisfaction and poorer psychological well-being among these students.

Importantly, resilience played a positive role by mitigating the negative impact of

pandemic-related stress on the life satisfaction and psychological well-being of student

nurses. In Manila, Philippines, a study conducted by Daniel Joseph E. Berdida and Rizal

Angelo N. Grande (2022) focused on the connection between the quality of life (QoL) and

academic resilience of nursing students during the COVID-19 pandemic. Surprisingly, the

research found no significant association between QoL and academic resilience concerning

participants' profile variables. However, the gender and year level of nursing students

emerged as significant predictors of both QoL and academic resilience in the study.

In Zamboanga City, Jewel Caesar T. Mangundayao (2023), a post-nursing graduate in

Ateneo De Zamboanga, emphasized that nursing students on duty in psychiatric wards

need emotional preparedness to handle both patient and personal emotions. Exposure to
the psych ward helps them understand mental illnesses better, fostering empathy and

improving therapeutic communication skills. However, it can have negative effects,

potentially triggering undiagnosed mental illnesses in students struggling with coping and

self-care.

While there is existing literature explores the lived experiences of student-nurses in

various clinical settings (Devi, et.al, 2022), there is a significant research gap regarding the

lived experiences of student-nurses during their exposure to psychiatric environment.

Previous studies have not delved deeply into the unique challenges and experiences faced

by these students, leaving unanswered questions about coping mechanisms, support

systems, and the long-term effects of such exposure.

Addressing the experiences of student-nurses in psychiatric nursing environments

is urgent due to immediate and long-term implications. In the short term, it impacts the

well-being of student-nurses and patient care quality. In the long term, failure to act can

perpetuate inadequate mental health care and stigma, hindering societal progress in this

critical area. Timely research and action are essential for the well-being of individuals and

the advancement of mental health care services.

This study is socially relevant as it can positively impact individuals, their well-

being, and society. By understanding these experiences, we can improve student-nurses’

well-being, reduce stress, and enhance patient care. This research also contributes to better

mental health care practices, improved patient outcomes, and reduced stigma, benefiting

both those in psychiatric nursing and society as a whole.

Purpose of the Study

The purpose of this qualitative study is to explore the lived experiences of student

nurses who are exposed to psychiatric nursing environments. This study aims to

understand the challenges and opportunities that student nurses face in this setting, as well

as the impact that this experience has on their personal and professional development. This

study can also provide insights into the challenges and opportunities that nurses face in

this setting, which can be used to improve the delivery of psychiatric care.

Research Questions

1. What are the lived experiences of student nurses exposed in psychiatric nursing

environments?

a. What are the challenges and opportunities that student nurses face in

psychiatric nursing environments?

b. How do student nurses develop their professional and personal identities in

psychiatric nursing environments?

c. What are the factors that support or hinder student nurses’ learning and

development in psychiatric nursing environments?

2. How do student nurses’ experiences in psychiatric nursing environments shape

their views on mental health and psychiatric nursing?

a. What are student nurses’ initial perceptions of mental health and psychiatric

nursing?
 b. How do student nurses’ perceptions change as a result of their clinical

experiences in psychiatric nursing environments?

c. What are student nurses’ hopes and aspirations for the future of psychiatric

nursing?

3. What are the implications of student nurses’ lived experiences in psychiatric

nursing environments for nursing education and practice?

a. What are the needs of student nurses in psychiatric nursing environments?

b. How can nursing education programs better prepare student nurses for the

challenges and rewards of psychiatric nursing?

c. How can psychiatric nursing practice be improved to support student nurses’

learning and development?

Theoretical Lens

The theoretical lens of phenomenology is particularly relevant when examining the

lived experiences of student-nurses immersed in psychiatric nursing environments.

Phenomenology, as developed by philosophers like Husserl and Merleau-Ponty, focuses on

understanding the essence of human experiences, emphasizing the subjective reality and

consciousness of individuals. In the context of student-nurses, this theoretical perspective

can uncover the intricate layers of their encounters within psychiatric nursing settings,

elucidating the meaning they ascribe to their experiences, the emotions evoked, and the

intricate interplay between their perceptions and the external environment.

Through the lens of phenomenology, researchers can delve into the essence of the

students' encounters, exploring their first-hand narratives, reflections, and interpretations

of the events and interactions within the psychiatric nursing environment. By embracing

the students' subjective realities, phenomenology enables an exploration of the subtle

nuances that shape their understanding of mental health care and their role as caregivers.

It allows for the revelation of the underlying motives, intentions, and consciousness of

student-nurses as they grapple with the complexities, challenges, and rewards inherent in

psychiatric nursing.

Furthermore, employing phenomenology facilitates a holistic comprehension of the

unique ways in which student-nurses navigate the emotional landscapes within psychiatric

settings, providing insights into their coping mechanisms, personal growth, and evolving

professional identities. This theoretical lens encourages researchers to approach the study

with an open mind, acknowledging the significance of individual perspectives and

experiences in shaping the broader understanding of the lived realities within psychiatric

nursing environments. By incorporating phenomenology, this research can capture the rich

tapestry of student-nurses' encounters, elucidating the profound impact of these

experiences on their personal development and their future roles as empathetic and skilled

psychiatric caregivers.

Scope and Limitations of the Study

This study focused on lived experiences of student-nurses exposed in psychiatric

nursing environments. The study involves 14 fourth year nursing students of Pilar College

of Zamboanga City, Inc. The survey is conducted to know the lived experiences that the

student have experienced when they were rotated in the area. The study did not involve

first year, second year and third year nursing students as they still do not have exposure to
the psychiatric ward. Therefore, this study could not be generalized since the number of

participants was relatively small and did not represent the entire populace of nursing

students of Pilar College of Zamboanga City, Inc.. This also implies that the outcomes of the

study should not be assumed in a larger context.

Importance of the Study

To contribute to the community and the goal of research, the product of the study

will be beneficial to the following entities:

The study will help the student nurses to understand and prepare for the

challenges and rewards of working in psychiatric nursing environments. It can also provide

them with insights into how to cope with stress, anxiety, and other difficult emotions that

they may experience during their clinical placements.

The study will help the psychiatric nursing educators to develop more effective

and supportive learning experiences for their students. It can also provide them with

insights into how to better prepare students for the realities of working in psychiatric

nursing environments.

The study will help the psychiatric nursing practitioners to better understand the

experiences of their student nurses. It can also provide them with insights into how to

better support and mentor their students.

The study will help the mental health professionals to better understand the

needs of psychiatric nursing students, and to provide them with the support they need to

succeed.
 The study will help will help to improve the quality of care that psychiatric nurses

provide to their patients and their families.

Future researchers can benefit from the study by gaining a better understanding of

the current state of research on the lived experienced of student-nurses in psychiatric

nursing environments.

Definition of Terms

Lived Experiences. Refers to the collection of events, incidents, and interactions

that an individual undergoes throughout their life. These experiences contribute to shaping

their perspectives, beliefs, and understanding of the world around them. Lived experiences

are inherently subjective and unique to each individual, encompassing various aspects of

personal, social, and cultural encounters. They often form the basis for an individual's

knowledge, emotions, and memories, influencing their behavior and decision-making

processes.

Student Nurses. Are individuals who are currently enrolled in a nursing education

program, typically within a college or university, to pursue a career in nursing. They

undergo a comprehensive curriculum that includes theoretical and practical training in

various aspects of patient care, medical procedures, healthcare ethics, and communication

skills. Throughout their training, student nurses acquire the necessary knowledge, skills,

and clinical experience required to provide quality nursing care under the guidance of

experienced nursing instructors and healthcare professionals.

Psychiatric Nursing Environments. Refer to specific healthcare settings where

nursing professionals provide specialized care and treatment to individuals with mental
health disorders and conditions. These environments are tailored to address the unique

needs of patients dealing with various psychiatric illnesses, including but not limited to

schizophrenia, bipolar disorder, depression, and anxiety disorders. Within these

environments, nursing professionals focus on managing, supporting, and assisting patients

in their recovery process, often employing therapeutic techniques, medication

administration, and psychological interventions to promote mental well-being and

stability.

Qualitative Study. Is a research method that focuses on gathering non-numerical

data, such as texts, images, or observations, to gain an in-depth understanding of a

particular phenomenon. It involves exploring and interpreting the underlying meanings,

patterns, and themes within the data. Qualitative studies often employ techniques such as

interviews, focus groups, participant observation, and textual analysis to collect rich,

descriptive information. Researchers use this approach to uncover insights into people's

behaviors, attitudes, experiences, and perceptions, providing a deeper understanding of the

context and complexities surrounding a specific topic.

Organization of the Study

This study is written and laid out in a way that readers can easily follow and

comprehend. The following is a brief overview and discussion of the study's structure:

Chapter 1 presents the background of the study and purpose of the study: exploring

the experiences of student nurses exposed in psychiatric nursing environments. Research

questions were posed and significance term were conceptually.

 Chapter 2 highlights the review of related literature and relevant studies similar to

the focus of the research. The researcher gathered and obtained the research through

internet articles and publications while ensuring reliable sources.

Chapter 3 presents the methodology that the researcher employed in conducting the

research. It includes the researcher’s role, research participants, data analysis, data

collection, credibility and trustworthiness of the study, and ethical consideration.

Chapter 4 shows the results of the study. It provided an analysis of the data and the

presentation of the results. In addition, relevant statements from the participants were

quoted and reflected in this chapter.

Chapter 5 discusses the summary of the study, the collected data from the in-depth

interview, and focus group discussion. The chapter also covered the different themes

created from the participants’ responses and the implications of the study for further

research.
 CHAPTER 2

Review of Related Literature

In a related review of literature, previous research has shed light on the critical

issue of workplace violence experienced by psychiatric nurses in inpatient psychiatric

units. Abdallah Abu Khait , Shaher H. Hamaideh , Mohammed Aldalaykeh , Ayat ALhamdan

and Mark Lazenby (2022) conducted a comprehensive study employing a descriptive,

phenomenological research approach to understand the experiences and aftermath of

assaults on psychiatric nurses. Their findings revealed three overarching themes: the

prevalence of a hostile work environment conducive to physical and psychological

violence, the psycho-emotional consequences endured by nurses following such assaults,

and proactive strategies to combat violence. The study emphasized the importance of

recognizing the psychological and emotional toll such violence takes on nurses,

highlighting the need for mental health and emotional support, especially for those with

extensive exposure to violence in their workplace. This research contributes significantly

to the ongoing discourse on addressing workplace violence in psychiatric settings and

underscores the need for comprehensive strategies to mitigate its impact on nurses’ well-

being (Abdallah Abu Khait , Shaher H. Hamaideh , Mohammed Aldalaykeh , Ayat ALhamdan

and Mark Lazenby, 2022)

In another study conducted by Gunaydin and Coban (2021) conducted a study

highlighting the challenges faced by students in their clinical practice, particularly in a

psychiatry clinic at a university hospital in Tü rkiye. The research revealed that students
encountered difficulties in coping with negative emotions and expressed a need for

supportive interventions to address these emotional challenges. Additionally, they faced

hurdles in effectively translating theoretical knowledge into practical skills, often

emphasizing the absence of role model nurses and lecturers during their clinical

experiences. This study underscores the importance of providing students with the

necessary emotional support and guidance to bridge the gap between theoretical learning

and clinical practice in the field of psychiatric nursing (Gunaydin & Coban, 2021).

Rahmani, Mohammadi, and Fallahi-Khoshknab (2021) conducted a study shedding

light on the negative experiences of nursing students during their psychiatric nursing

studentship period. The research revealed that many students exhibited a lack of interest

in rotating to psychiatric wards due to the substantial stress, emotional burnout, and the

prevailing negative public attitude toward psychiatric nursing. These challenges

underscore the urgency of developing effective strategies to increase students’ interest in

pursuing careers in psychiatric nursing and addressing the issues that deter them from

embracing this field. The study highlights the need for comprehensive support and

initiatives to promote a more positive perception of psychiatric nursing and alleviate the

stress and emotional burnout associated with it (Rahmani, Mohammadi, & Fallahi-

Khoshknab, 2021).

Mashamba-Thompson (Nurs. Rep., 2023) conducted a study examining the

experiences of professional nurses concerning student nurses’ absenteeism during

psychiatric clinical placements in Limpopo Province, South Africa. The research sought to

gain insights into the reasons behind student absenteeism and its repercussions for both
students and the healthcare system. The study elucidated the challenges encountered by

nursing students during their clinical training and underscored the far-reaching

implications of their absence on their learning outcomes and professional development. It

highlights the pressing need to address the root causes of absenteeism to enhance the

quality of nursing education and ultimately improve patient care within the psychiatric

clinical setting.

Hange and Khare (2021) conducted a study that delves into the intricacies of

learning in clinical environments, emphasizing both its benefits and challenges. Their

research focused on the learning challenges faced by nursing students in clinical settings in

Iran. The study involved 18 undergraduate nursing students selected through purposive

sampling from the Faculty of Nursing and Midwifery of Tehran and Shahid Beheshti

Universities. Semi-structured interviews were employed to gather data, and content

analysis was used to identify relevant themes. Two prominent themes emerged from the

data analysis, shedding light on the students’ clinical learning challenges: the insufficient

qualification of nursing instructors and the unsupportive learning environment. The study

highlights the need for addressing these issues to enhance the quality of nursing education

and provide a more conducive clinical learning experience for students (Hange & Khare,

2021).

Alhamidi and Alyousef (2021) highlighted the positive impact of placing

undergraduate nursing students in clinical settings related to mental health practice. The

study emphasized how such clinical placements can help students address anxiety and

stress associated with patient interactions, tackle stigmatization and negative emotions,
apply theoretical knowledge in real clinical scenarios, develop therapeutic communication

skills, and enhance their overall professional experiences. It was suggested that these

placements provide nursing students, especially those interested in mental health practice,

with valuable knowledge and perspectives that can benefit their future careers across

various healthcare fields. The study underscores the significance of integrating mental

health-related clinical experiences into nursing education to equip students with the

necessary skills and insights (Alhamidi & Alyousef, 2021).

Chachula KM, Varley (2022), states that students in undergraduate nursing and

psychiatric nursing programs are future professionals entering a health care climate rife

with violence and anxiety provoking life and death experience, The study reveals that

participants self-identify as being traumatized and/or act on their experiences and feeling

of clinical related trauma. Another important contribution of their study is to understand

the students vulnerabilities and the circumstances surrounding the traumatic events to

inform how educators can engage students that promote resilience, emotional intelligence

development, and coping skills.

Basogul C. (2021), states that positive or negative beliefs which are developed by

the health professionals toward the psychiatric patients and the mental illness affect the

quality of healthcare offered to the patient. This study aimed at exploring the views of

nursing students who have experienced caring for psychiatric patients on mental illness

and stigma. It was identified that the nursing students shared common views about the

reasons for the stigmatization and the recommendations for reducing it, and the

psychiatric nursing course gave rise to positive changes in students' emotions, thoughts,
and behaviors about the mental illnesses. Moreover, it will make contributions to the

enhancement of quality and satisfaction in patient care in the long run. In raising the

awareness of the students about mental illnesses and stigmatization and developing their

therapeutic communication skills. Therefore, nursing education plays a big role in shaping

nursing students' attitudes toward people with mental disorders and can shape these

negative attitudes in a positive direction.

Zhang (2021) conducted a study focusing on the challenges and changes

encountered by nursing students during their psychiatric clinical practice experiences. The

research illuminated a dynamic process in which nursing students’ professional maturity

and personal growth in the realm of psychiatric care evolved over time. Four central

themes emerged: negative stereotypes surrounding mental illness, professional

development, personal growth, attitudes toward psychiatric patients, and career choice.

While some nursing students did not ultimately opt for a career in mental nursing, the

study provides valuable insights for educators on how to optimize the internship

experience and implement comprehensive changes to enhance the professional appeal and

identity of psychiatric nursing. This research underscores the need for ongoing support

and development to guide nursing students through the complexities of psychiatric clinical

practice (Zhang, 2021).

Additionally, Demir (2018) conducted a qualitative study utilizing

phenomenological techniques to explore the clinical experiences of student nurses during

their initial interactions with mental patients. The research emphasized the significance of

building therapeutic relationships, which led to a reduction in stigma associated with

mental illness within clinical practice. Students expressed the idea that psychiatric clinical

practice provided a platform for the development of meaningful interpersonal

relationships and underscored the critical role of effective communication in the treatment

of mental illnesses. The study identified four key themes: personal growth and

communication, highlighting the transformative nature of clinical encounters with mental

patients and their impact on student nurses’ attitudes and skills in psychiatric care (Demir,

2018).