Mental Wellbeing

Education for Mental Health Toolkit - Placements

As noted in Prepare and support students in non-traditional spaces, placements offer significant learning opportunities to students but can also increase the level of challenge, beyond a point which is sustainable (1, 2).

Placements

As noted in Prepare and support students in non-traditional spaces, placements offer significant learning opportunities to students but can also increase the level of challenge, beyond a point which is sustainable (1, 2). When placements go well, they can enhance student learning and preparation for the future, when they go badly, they can undermine student persistence, self-belief and wellbeing. A survey of 3,527 UK students, in 2008, found that 39% considered dropping out due to experiences on clinical placements (3). The research literature suggests that work-integrated learning in workplaces needs better preparation and support to positively contribute to student wellbeing and learning outcomes (4). This suggests that there is a need to incorporate effective and appropriate strategies into pedagogical and institutional practice to support students and to positively contribute to their wellbeing during placements. 

Education for Mental Health

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Placements create a range of challenges for students, which individually may be helpfully stretching for some, but which can be overwhelming in combination or if students have not been adequately prepared (3, 5). For students on professional programmes, a constant stream of new placements, in new workplaces, with new colleagues can create a constant sense of transition (6). Many students report imposter syndrome and a lack of confidence in their own skills in the workplace, which can significantly undermine wellbeing and achievement (7-9). 

The environment of the placement itself can also be a factor in determining wellbeing – workplace culture, personalities and expectations can have both positive and negative impacts on wellbeing (2, 3). Alongside these challenges, many students will also be managing other commitments and responsibilities which can push them beyond a point of healthy sustainability. A study conducted by Mills, Ryden and Knight (10) found nursing students’ wellbeing was negatively influenced by juggling multiple demands, such as demands on their physical capabilities, personal resources, income, and time, and constantly finding a way to balance these things and develop their own coping strategies.

According to research there are several things that could support students on placements:

  • Well trained and available peer mentors while on placement can help to increase wellbeing. Oates and colleagues (11) suggest that students value chances for individual support and opportunities to connect with their peers.
  • Studies also suggest that universities should ensure that support services are accessible and relevant to students on placement (11)
  • Providing workshops, within curriculum, specifically designed to help students prepare for and manage placement may help to improve students’ performance, learning and wellbeing on placement:
  • A study by Sweeney (12) found that providing students a 1-day workshop on imposter syndrome improved their wellbeing and participating students reported feelings of liberation and empowerment.
  • Oates et al. (11) highlight the importance of explicitly developing students’ skills and appropriate levels of confidence prior to going on placement.
  • Research has shown that developing a professional identity and career path can be a protective factor in work-based learning. Explicitly focussing curriculum on the development of professional identity may help students feel equipped to manage the challenges of placement (14, 15)
  • Benefit may also be gained from providing workshops to help students’ development of self-management skills, including managing emotions, thoughts and behaviours, in advance of placement. Provision of post-placement learning workshops to help students understand their experiences, extract learning and build self-belief will consolidate what they have learned.
  • Scammell (15) suggests a formal wellbeing ‘check in’ two weeks into any placement.              

Key lessons

  • Placements offer significant learning opportunities to students but can also increase their level of challenge, beyond a point which is sustainable
  • Research has shown that experiences on placements are one of the main factors linked to attrition
  • Student wellbeing can be impacted by having to manage a range of challenges alongside placement, the environment of the placement itself, lack of preparation and doubts about ability
  • Students can be supported to be successful on placement through curriculum content that specifically prepares them for placement, addressing the challenges of self-management, imposter syndrome, building self-efficacy and developing professional identity.

Top tips

  • Use peer mentors to helps students prepare for the reality of placement and to provide ongoing informal support
  • Establish wellbeing check-ins with students two weeks into placement.
  • Embed workshops into the curriculum to specifically prepare students for the practicalities of their placement and to learn from their experience post placement.
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References
  1. Ryan G, Toohey S, Hughes C. The purpose, value and structure of the practicum in higher education: A literature review. Higher Education. 1996 Apr 1;31(3):355-77.
  2. Deasy C, Coughlan B, Pironom J, Jourdan D, Mannix-McNamara P. Psychological distress and coping amongst higher education students: A mixed method enquiry. Plos one. 2014 Dec 15;9(12):e115193.
  3. Bertulis R, Cheeseborough J. The Royal College of Nursing's information needs survey of nurses and health professionals. Health Information & Libraries Journal. 2008 Sep;25(3):186-97.
  4. Grant-Smith D, Gillett-Swan J, Chapman R. WIL Wellbeing: Exploring the Impacts of Unpaid Practicum on Student Wellbeing. Report submitted to the National Centre for Student Equity in Higher Education (NCSEHE). Curtin University: Perth. 2017.
  5. Pryjmachuk S, Easton K, Littlewood A. Nurse education: Factors associated with attrition. Journal of advanced nursing. 2009 Jan;65(1):149-60.
  6. Ford K, Courtney-Pratt H, Marlow A, Cooper J, Williams D, Mason R. Quality clinical placements: The perspectives of undergraduate nursing students and their supervising nurses. Nurse Education Today. 2016 Feb 1;37:97-102.
  7. Haney TS, Birkholz L, Rutledge C. A workshop for addressing the impact of the imposter syndrome on clinical nurse specialists. Clinical Nurse Specialist. 2018 Jul 1;32(4):189-94.
  8. Parkman A. The imposter phenomenon in higher education: Incidence and impact. Journal of Higher Education Theory and Practice. 2016 Feb 1;16(1):51.
  9. Legassie J, Zibrowski EM, Goldszmidt MA. Measuring resident well-being: impostorism and burnout syndrome in residency. Journal of general internal medicine. 2008 Jul;23(7):1090-4.
  10. Mills A, Ryden J, Knight A. Juggling to find balance: hearing the voices of undergraduate student nurses. British Journal of Nursing. 2020 Aug 13;29(15):897-903.
  11. Oates J, Topping A, Watts K, Charles P, Hunter C, Arias T. ‘The rollercoaster’: A qualitative study of midwifery students’ experiences affecting their mental wellbeing. Midwifery. 2020 Sep 1;88:102735.
  12. Sweeney S, Schmidt P. Lesson Plan for Teaching Four Stories Featuring Multi/Mixed Identities. English Literature Faculty Works. 2018. Available from: doi: 10.24968/2476-2458.engl.353
  13. McKenna L, McCall L, Wray N. Clinical placements and nursing students' career planning: A qualitative exploration. International Journal of Nursing Practice. 2010 Apr;16(2):176-82.
  14. Stockhausen LJ. Learning to become a nurse: students' reflections on their clinical experiences. Australian Journal of Advanced Nursing, The. 2005 Mar;22(3):8-14.
  15. Scammell J. Supporting mental wellbeing in pre-registration nursing students. British Journal of Nursing. 2019 Apr 10;28(7):471.