Issues in Mental Health Nursing, 35:330–336, 2014
Copyright © 2014 Informa Healthcare USA, Inc.
ISSN: 0161-2840 print / 1096-4673 online
DOI: 10.3109/01612840.2013.863413
The Views of Heads of Schools of Nursing about Mental
Health Nursing Content in Undergraduate Programs
Brenda Happell, PhD, RN
Central Queensland University, Institute for Health and Social Science Research, Centre for Mental
Health Nursing, and School of Nursing and Midwifery, Rockhampton, Australia
Margaret McAllister, RN, MHN, Ed D
Central Queensland University, Institute for Health and Social Science Research, Centre for Mental
Health Nursing, and School of Nursing and Midwifery, Noosa, Australia
Criticisms about the mental health nursing content of Bachelor
of Nursing programs have been common since the introduction
of comprehensive nursing education in Australia. Most criticism
has come from the mental health nursing sector and the views
of key stakeholders have not been systematically reported. Heads
of Schools of Nursing have considerable influence over the con-
tent of nursing programs, and their perspectives must be part of
ongoing discussions about the educational preparation of nurses.
This article reports the findings of a qualitative exploratory study,
involving in-depth interviews with Heads of Schools of Nursing
from Queensland, Australia. Thematic data analysis revealed two
main themes: Realising the Goal? and Influencing Factors. Over-
all, participants did not believe current programs were preparing
graduates for beginning level practice in mental health settings. In
particular, participants believed that the quality of mental health
content was influenced by the overcrowded curriculum, the avail-
ability of quality clinical placements, the strength of the mental
health team, and the degree of consumer focus. The findings sug-
gest the current model of nursing education in Australia does not
provide an adequate foundation for mental health nursing prac-
tice and alternative approaches should be pursued as a matter of
urgency.
The introduction of comprehensive education for the prepa-
ration of registered nurses reflects an ongoing campaign for
nurses to receive broad and general skills and knowledge at
the undergraduate level, with specialisation in specific fields of
nursing practice to occur at postgraduate level (Happell, 1998).
The current picture of educational preparation for nurses, how-
ever, has been described as quite disparate from the initial vision
(Happell & Cutcliffe, 2011; Holmes, 2006; Stuhlmiller, 2005;
Warelow & Edward, 2009).
Address correspondence to Brenda Happell, Centre for Men-
tal Health Nursing Innovation, Building 18, Bruce Highway,
Rockhampton, 4702 Australia. E-mail: b.happell@cqu.edu.au
The original intention to prepare nursing graduates for be-
ginning practice in a broad range of health care has not been
realised despite numerous reports and inquiries highlighting the
relative underrepresentation of mental health content in nurs-
ing curricula (Happell, 2010). The most recent report into the
undergraduate preparation of nurses for mental health practice
(Mental Nurse Education Taskforce, 2008), described the long-
standing inadequacy of mental health nursing content (Moxham,
McCann, Usher, Farrell, & Crookes, 2011), reinforcing what
has consistently been noted in the literature (Happell, 1998;
Happell, 2010; Happell & Cutcliffe, 2011; McCann, Moxham,
Usher, Crookes, & Farrell, 2009; Moxham et al., 2011; Warelow
& Edward, 2009; Wynaden, 2012).
The report, subsequently endorsed by the Council of Deans
of Nursing and Midwifery, included principles to underpin the
development of the mental health component, including the need
for discrete and compulsory content to be covered each year
throughout the three-year program; the requirement that content
be taught by staff with the relevant expertise and qualifications;
and the need for consumer involvement in the preparation and
delivery of content (Mental Nurse Education Taskforce, 2008).
Challenges to the quality and quantity of mental health nurs-
ing content have been documented over time; mental health
nursing has a lack of popularity in comparison to other areas
of specialty practice, posing a serious barrier to change (Clin-
ton, 2001; Happell, 2008b; Happell & Gaskin, 2013; Stevens,
Browne, & Graham, 2013; Surgenor, Dunn, & Horn, 2005). We
do know attitudes to mental health nursing can be positively
influenced by education (Curtis, 2007; Happell, 2008a; Happell
& Gaskin, 2013; Henderson, Happell, & Martin, 2007; O’Brien,
Buxton, & Gillies, 2008) and by consumer involvement in ed-
ucation, in particular (Anghel & Ramon, 2009; Byrne, Hap-
pell, Welch, & Moxham, 2013b; Happell, Pinikahana, & Roper,
2003; Happell & Roper, 2003). The literature also suggests that
the number of mental health nurse academics is insufficient,
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