Journal of Nursing Education

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Using Active Learning Strategies to Increase Understanding of Mental Health Concepts

Sandra S. Lee, PhD, RN, CNE; Tracy McManaman-Bridges, MSN, RNC-OB, C-EFM

Mental health is a public health crisis. Nearly one in five adults has a mental health illness (National Institute of Mental Health, 2018). However, psychiatric disorders affect the majority of patients being cared for by nurses in the United States (Psychiatric Mental Health Substance Abuse Essential Competencies Task Force, 2012). Baccalaureate educated nurses should be prepared to care for patients across all settings, with special attention paid to chronic illness, including mental disorders (American Association of Colleges of Nursing, 2008; Kane, 2015). Therefore, nursing students must develop basic competency to care for individuals with mental health diagnoses before they transition into professional practice.

Learning Goal and Objective

The goal was to increase accelerated second-degree baccalaureate nursing degree students' understanding of mental health concepts. Students were co-enrolled in a psychiatric mental health clinical and didactic course. The course included 30 contact hours of classroom instruction and 90 clinical practice hours. Clinical included a combination of 40 hours in the acute psychiatric inpatient setting, 5 hours in an outpatient group setting, and 45 hours of high-fidelity, low-fidelity, and virtual simulation. Multiple outcomes were evaluated, including high-fidelity simulation completion, clinical performance, instructor-designed examination performance, student course evaluation data, and a national standardized proctored assessment that measures mental health concept proficiency associated with the NCLEX-RN®. The faculty had noted low proficiency scores on the national assessment for the previous 2 years, few opportunities for mental health high-fidelity simulation in the curriculum, and student difficulty connecting clinical experiences to classroom learning. Specifically, the faculty aimed to use innovative teaching strategies for students to (a) achieve simulation outcomes for better clinical preparation; (b) demonstrate improved performance on examinations; and (c) achieve better scores on the national assessment administered at the end of the course.

Strategy Description

Faculty referenced the American Psychiatric Nurse's Association undergraduate education faculty tool kit to ensure that class topics were sufficient and relevant with current evidence-based standards (American Psychiatric Nurses Association Education Council, 2016). The tool kit relates core undergraduate nursing content to the Psychiatric-Mental Health Nursing Scope and Standards of Practice (American Nurses Association, 2014). Faculty introduced multiple active learning strategies into the classroom and simulation environment: (a) revised the current classroom slides to reflect the most evidence-based practice; (b) increased the mastery requirement for weekly NCLEX-RN–styled quizzes; (c) presented weekly overviews of psychiatric medication classifications called “medication moments”; (d) held weekly meetings to evaluate and revise the teaching strategies; (e) reviewed content weaknesses of the practice assessments and instructor-designed unit examinations with students before the final proctored assessment; (f) added mental health simulations, including high-fidelity scenarios in therapeutic communication, assessment of suicide risk, crisis de-escalation, and care of a patient in alcohol withdrawal; (g) aligned simulations with weekly class content and topical objectives; (h) informed students on the first day of class about historical aggregate performance scores and challenged them to exceed previous class scores; (i) required students to keep laptops closed during class to minimize distraction; (j) incorporated online, interactive case studies into the course requirements; and (k) used a structured postconference template to stimulate clinical reasoning and connect the clinical experience to classroom learning.


After active learning strategies were introduced, 100% of students successfully completed the high-fidelity simulation checkoffs, and 100% of students achieved the clinical performance expectations. Student feedback on the final course evaluations indicated increased learning and engagement in psychiatric nursing content. Students' proficiency scores on the national assessment and instructor-designed examinations improved, indicating a more complete understanding of mental health care nursing.

Correlation to Nursing Education and Practice

Nursing education programs have significantly lessened psychiatric mental health content in recent years due to the reduction of psychiatric items on the NCLEX-RN (Kane, 2015). Active learning strategies and intentional course revision facilitated understanding of mental health nursing concepts by accelerated, second-degree baccalaureate nursing degree students. All students were successful on the high-fidelity simulations and clinical performance, and almost 90% of students exceeded minimum expectations for performance in mental health content. A robust inquiry is needed to examine the effects of individual variables on student outcomes.

Sandra S. Lee, PhD, RN, CNE
Tarleton State University

Tracy McManaman-Bridges, MSN,
University of Houston


  • American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education for professional nursing practice. Retrieved from
  • American Nurses Association. (2014). Psychiatric-mental health nursing scope and standards of practice (2nd ed.). Silver Spring, MD: Author
  • American Psychiatric Nurses Association Education Council. (2016). Crosswalk tool-kit: Defining and using psychiatric-mental health nursing skills in undergraduate nursing education. Retrieved from
  • Kane, C.F. (2015). The 2014 scope and standards of practice for psychiatric mental health nursing: Key updates. Online Journal of Issues in Nursing, 20, 1.
  • National Institute of Mental Health. (2018). Statistics. Retrieved from
  • Psychiatric Mental Health Substance Abuse Essential Competencies Task Force. (2012). Essential psychiatric, mental health and substance use competencies for the registered nurse. Archives of Psychiatric Nursing, 26, 80–110. doi:10.1016/j.apnu.2011.12.010 [CrossRef]

The authors have disclosed no potential conflicts of interest, financial or otherwise.


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