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Is Nursing Students' Mental Health in Jeopardy?


In a study, faculty and students in nursing schools and other health sciences at 10 large U.S. universities reported suboptimal lifestyle behaviors and high levels of stress. Nursing school students, however, had higher levels of depression, anxiety, and stress than nursing faculty and medical students. [caption id="attachment_104649" align="alignleft" width="200"] Bernadette Mazurek Melnyk, APRN[/caption] The study was conducted prior to the pandemic, which suggests things have likely gotten worse, according to lead study author Bernadette Mazurek Melnyk, PhD, APRN-CNP, FAANP, FNAP, FAAN, Vice President for Health Promotion, University Chief Wellness Officer and College of Nursing Dean at The Ohio State University. "We have a horrible mental health epidemic going on inside of the COVID-19 pandemic," said Melnyk, citing the U.S. Surgeon General's advisory released in December 2021 on the mental health crisis among young people. But there are steps that universities and healthcare systems can take to improve students' and faculty's mental health and lifestyle choices, according to Melnyk, who developed the cognitive-behavioral skills building MINDSTRONG/MINDBODYSTRONG programs. Universities and healthcare systems nationwide use these evidence-based programs to reduce stress, anxiety, depressive symptoms, and suicidal ideation. The programs also help improve healthy lifestyle behaviors in college students, nurses, and clinicians. Prior studies also have shown improvements in academic performance.

Studies Look at Students' Stress

Melnyk and coauthors described rates of mental health problems and healthy lifestyle behaviors reported by faculty and students from medicine and nursing. They compared the data to that from an "other" category of students and faculty from fields such as dentistry, pharmacy, public health, and social work.

Of the 869 faculty and 1087 students who responded, about 50% reported getting the recommended seven hours of sleep a night, and a third achieved 150 minutes of physical activity a week.

Students had more depression at 9.9% compared to faculty at 5.5%. More students also had anxiety -- 25.5% compared to faculty at 11.5%. Students also were less likely to report having at least five daily servings of fruits and vegetables or getting at least seven hours of sleep a night or at least 150 minutes of weekly physical activity. A research brief in the Journal of Nursing education also discovered that nursing students had "significantly more stress, anxiety, sleep disturbances, and stress-related illnesses" compared to the general student body.

Making Wellness Part of the Culture

[caption id="attachment_104683" align="alignright" width="239"] Melissa Burdi, DNP[/caption] Melissa Burdi, DNP, Purdue University Global Vice President and Dean of the School of Nursing, says maintaining the mental health of faculty and students is top of mind at the nursing school. Purdue Global, she said, addresses mental health in all its nursing degree programs. "During the pandemic, the faculty and staff at Purdue University Global School of Nursing have undergone training on Social Determinants of Health (SDOH) specific to the Healthy People 2030 framework to further understand the impact that socioeconomic, mental health needs, and food insecurities, as an example, can have on student learning," Burdi said. Purdue Global offers employee and student assistance programs designed to provide a variety of support options. University leadership must build wellness cultures, according to Melnyk. But first, they have to fix systemic issues that cause burnout. If the system is broken, with issues like short staffing, work overload, and electronic medical record problems, all the wellness programs in the world won't help much, she added.

"You have to fix system issues and provide wonderful resources, culture, and evidence-based programs for your people," she said.

Melnyk's nationally conducted research on healthy lifestyle behaviors in nurses and providers suggests that faculty are not walking the walk, she said.

"Faculty are not integrating wellness into their culture and curricula," said Melnyk. "We are going to grow up another generation of students that don't practice good self-care."

So, how could nursing schools incorporate wellness into the curriculum, especially with so many students taking online classes? Melnyk said that Ohio State has implemented a wellness culture, with a menu of evidence-based programming, health coaches and a telehealth wellness hub. "We provide all of those types of programs and resources, and we build these programs into our curricula," she said. "It's in our vision. We have a whole strategic plan around this. That is what a lot of institutions are not doing." Ohio State, for example, has rolled out systemwide programs to improve faculty and student mental health and wellness. Among the options is an evidence-based cognitive skill building program. "That's because we know cognitive behavioral therapy is the best evidence-based treatment for depression and anxiety, but so few people get it," Melnyk said. To overcome the stigma around mental health, Ohio State also provides anonymous mental health screenings with an interactive screening program offered by the American Foundation for Suicide Prevention.

"A nurse cannot often make the system changes needed, but nurses can advocate for them. Seriously, we do a great job caring for everybody else, but we often don't prioritize our own self-care," Melnyk said.

Mental Health Support Resources

Melnyk and Burdi provided the following resources for nursing students and nurses: The National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience Suicide Prevention Lifeline or call toll-free at 800-273-8255 Addiction - Substance Abuse and Mental Health Services Administration or call toll-free at 1-800-662-4357 Alcoholics Anonymous Narcotics Anonymous Eating Disorders Rape, Abuse & Incest National Network National Domestic Violence Hotline or call toll-free 800.799.SAFE (7233), if you're concerned your internet usage might be monitored. Covenant House (For adolescents impacted by housing and food insecurity and mental health needs) Join our nurse community and connect with nurses across the country!