Psychiatric clinical course strengthens the student–patient relationships of baccalaureate nursing students


  • Qualifications: Dr Ketola is a RN and licensed clinical psychologist. She has worked in mental health since 1980; Dr Stein has been an educator in psychiatric community mental health nursing since 1981.

  • This study was conducted by the authors while teaching in the School of Nursing at California State University, Long Beach.

J. Ketola, School of Nursing, California State University, 1250 Bellflower Boulevard, Long Beach, CA 90840-0902, USA, E-mail:


Accessible summary

  • • It is stressful to be ill. People need nurses who help them emotionally while caring for their physical problems. The undergraduate psychiatric course is a good place to begin this learning. A pre and post survey asked 67 baccalaureate student nurses what they learned from their first clinical psychiatric nursing course. Specifically, the authors wanted to know whether working with people with mental illness would help students learn how to help people with emotional stress.
  • • The students developed skills in listening and communication and progressed through steps essential to the development of empathy: breaking down stigma and prejudicial judgments, developing skills of self-reflection, allowing people to impact them and feeling what it would be like if they were the patient, and recognizing what they had learned thereby making the learning conscious. With these new skills, students remarked on the life-changing experiences they had with these patients. Many commented on their intention to integrate these skills and understandings into their nursing practice with all patients.
  • • These study findings are important for three reasons: (1) recognition of the importance of the first psychiatric course in helping students develop empathy; (2) encouraging research to focus on faculty efforts to help students integrate these practices into other areas of nursing; and (3) recognition that empathy is a learned process.


Psychiatric nursing teaches students how to engage and communicate with patients who have severe emotional distress. Nurses need this knowledge as the majority of patients encountered in hospitals are distressed. This study explores the impact of a psychiatric clinical course in helping students learn to relate to distressed patients. The study used a mixed research methodology to survey 67 baccalaureate students about their experiences in the placement portion of the psychiatric nursing course. The pre-clinical questions focused on students’ anticipation regarding individuals with mental illness and how the clinical experience would affect them as nurses and as individuals. The post-clinical questions asked how the clinical experience affected them. The students stated that their time with patients had changed them. Ninety-nine per cent were no longer frightened of the patients. Students realized the patients were distressed and were glad to help them. This work sensitized them to the individual rather than the generic patient. It initiated a process in self-awareness, in sensitivity to the feelings of another person and in communication skills. These are steps in the development of an empathetic presence. The students recognized the need for these skills in all nursing. The authors recommend strategies to assist students in developing an empathetic presence.