Experience of students who participated in psychiatric nursing educational program aiming at competency development

Abstract

Purpose: To clarify experience of students who participated in psychiatric nursing educational program aiming at competency development.

Methods: We conducted a semi-structured interview with five students who participated in a psychiatric nursing educational program and analyzed the results qualitatively and descriptively.

Results: We generated 19 categories and 39 subcategories. The students reached [acquisition of diversity and multi-phase viewpoint] through team discussion and attempted to understand patients holistically, including [acquisition of patient’s viewpoints]. Moreover, they formed supportive relationships while [repeating trial and error] and gained self-understanding based on [egocentrism awareness].

Conclusion: Participation in this program increased students’ preparedness for psychiatric nursing practical training, believed to contribute to competency development. Some students had difficulty relating to patients and hesitated to express negative emotions while establishing supportive relationships. This indicates the need for an educational approach that encourages students to express negative emotions easily.

Introduction

The rapid population aging and changes in disease structures and medical systems have increased expectations for nurse position expansion and role modifications. The Japanese Ministry of Education, Culture, Sports, Science, and Technology (MEXT) and the Ministry of Health, Labour, and Welfare (MHLW) have repeatedly discussed strategies to improve basic nursing education in response to these demands. In 2017, The Japanese Ministry of Education, Culture, Sports, Science published “Model Core Curriculum of Nursing Education”¹⁾. In 2011, JANPU (Japan Association of Nursing Programs in Universities), commissioned by the Japanese Ministry of Education, Culture, Sports, Science, announced the nursing practice ability of 20 items in five groups as “the education based on core nursing practice abilities during a bachelor’s degree program”. Additionally, a report regarding core competencies during the nursing bachelor’s degree program and graduation goals²⁾ was published in 2018 based on these nursing education curricula. The report changed the category in core competencies to 25 items in six groups, the education policy in nursing education at universities. An education based on this category is demanded. Establishing regional medical care planning and community-based integrated care systems is important. However, an education program is needed to develop competencies, including building supportive relationships with patients and developing nursing practice skills for teamwork in various situations. Studies will require self-directed learning due to the uncertainty of future events. To achieve self-oriented education, universities should prioritize the “student perspective” over the “supplier perspective”³⁾. Active learning education is recommended to address these challenges. In the unpredictable future, students must learn independently. Universities must shift from a provider-oriented to a learner-oriented perspective to achieve learner-centered education. Recent strategies include promoting active learning-based education to address this issue. Evaluating education quality in large-scale universities should focus on learning outcomes rather than what is taught is essential.

The authors developed an activity-learning style psychiatric nursing education program focusing on three core competencies that are particularly important in psychiatric nursing education: Group I: basic competencies for comprehensive assessment of the subject, Group II: practical competence in basic human care, Group V: practical competencies related to diverse nursing environments and team systems.

This study aimed to identify the experiences of students who participated in a psychiatric nursing education program aimed at developing competencies. We believe this study’s findings will help develop more effective psychiatric nursing education programs.

Methods

Definition of terms

Competencies: The ability to perform complex tasks in a specific situation using knowledge, skills, and mental/social resources⁴⁾.

Experience: Student’s feelings, thoughts, and awareness as a result of their participation in the program.

Summary of the psychiatric nursing education program

The psychiatric nursing education program that aimed at competency development was one of the required subjects for the second semester of sophomore year at university A as a part of practice in psychiatric nursing, which we considered as a psychiatric pre-nursing practice for third-year students. Students learn about nursing patients with mental disorders or disabilities before practicing the psychiatric nursing education program and obtaining the credit. The psychiatric nursing education program includes four sessions based on the goals of “development of the ability to perceive the subject holistically”, “self-understanding”, “establishment of supportive relationships” and “building collaborative relationships” (Table 1).

Table 1. Summary of the psychiatric nursing education program.

Configuration		Content
Session 1
	Team formation Orientation & presentation of case studies Team discussion Team presentations & overall summary	* Subjects were assigned to teams using random allocation methods. * Subjects received an orientation about the content, schedule, and cases of the program. * Subjects discussed their questions and learning needs about the target with their teams. * Subjects presented and shared their learning objectives for the future to deepen their understanding of the target, based on the discussions they had with their teams.
Session 2
	Team test Team discussion Team presentations & overall summary	* Teams worked on 5 questions that could be answered in the format of the past nursing licensure exam, using the knowledge they had learned in previous classes. * Teams discussed and deepened their understanding of the target, each using the bio-psychosocial model. * Teams presented and shared their deepened understanding of the target, which was developed through team discussions.
Session 3
	Simulation exercise Debriefing (reflection) Team presentations & overall summary	* After a 5-minute simulation exercise in the roles of student, patient, and observer. * After a 5-minute simulation exercise, each participant fills out a reflection sheet (assessment of skills such as acceptance, empathy, and congruency, as well as thoughts and feelings about the experience, and areas for improvement) in 10 minutes. A 10-minute debriefing session is held using the reflection sheets. * Present and share degrees of accomplishment, and tasks, impression and awareness obtained in the team.
Session 4
	Team discussion Team presentations & overall summary	* Based on the reconstruction and self-evaluation of the scenes played by each student, a conference is held. * The team discusses the themes of the task sheet ((1) Communication skills, counseling techniques, and attitudes as a human service professional that could be utilized, (2) Insights and thoughts from self-reflection or others’ reconstruction and evaluation, and self-tendencies and communication patterns as a human service professional). * The team presents and shares the above contents of the discussion and impressions from the four sessions.

Below are three unique aspects of this program. First, considering the importance of teamwork for quality nursing care, we utilized the team-based learning method to form a group with a common objective^{5, 6)}. We created a team of five to six people and engaged in repeated discussions to increase students’ awareness of their role in the health and welfare team. Second, we used patient A for training for four sessions. After the team assessed patient A background, students participated in a simulation-based play in the psychiatric nursing practice in which all students played the role of either a student nurse, a patient, or an observer based on a script with possible scenarios that could occur with the patient (Table 2). By having some students play the role of patients, we intended to alleviate the concerns of students with almost no experience interacting with people with mental disabilities. The goal was for the student to develop empathy and perspective-taking skills by imagining the feelings and situations of patients with mental disabilities, a key component of sympathy. Third, students will discuss in teams during each session and present their findings after the final session. Repeated outputs were anticipated to progressively enhance cognitive, proactive, and autonomous learning retention. From September to November, students were required to prepare for each class during the weekly 90-minute session. Teachers facilitated the cognition process to promote student learning and ensure a seamless discussion.

Table 2. Scenario scene.

Case: Mr. A, a 32-year-old male patient, was diagnosed with schizophrenia at the age of 19.
His family history and upbringing, the course of his illness before admission, the situation at his first admission, his life in the community, and his condition from his second admission to the present were presented in advance.
Scenario 1	On the 3rd day of training, Mr. A remembers your name and you are gradually building a relationship. A check of the patient’s chart reveals that he has not bathed for more than one week. The patient has not taken a bath for more than a week.	[Opening words] Trainee: “Mr. A, may I have a word with you about bathing?”
Scenario 2	On the 4th day of training, the trainee is concerned about whether or not Mr. A will participate in the rehabilitation program. The last time we invited Mr. A to participate in the program, he was lying on his bed, saying, “Student, please go alone”.	[Opening words] The trainee: “Hi Mr. A, there’s a film scheduled for the afternoon. I heard it’s an interesting action movie. Would you like to go see it with me?”
Scenario 3	On the 5th day of training, Mr. A, who had few words and a hard expression on his face, spoke to himself, not so much to tell the trainees what he had been thinking about in anguish recently, but more to express his own inner turmoil.	[Opening words] Mr. A: “I can’t live like this, I can’t live like this...”.

Study method

This study used a qualitative descriptive research design. The study participants were five sophomores who participated in all four psychiatric nursing education program sessions. In February 2021, data were collected through semi-structured interviews.

Data collection method

We explained the purpose of the study to the principal of the study facility and obtained approval. We requested the students to participate in the study when the evaluation of the mentioned subject was completed. Students were asked to email our researcher if they consented to participate in the study following an information session about the study corporation. During the data collection, we followed the interview guidance. We conducted a semi-structured interview in person or remotely as requested by study participants while avoiding the three Cs (closed spaces, crowded places, close contact). The interview guidance included four items: “development of the ability to consider patients holistically”, “self- understanding”, “development of supportive relationships”, and “establishment of collaborative relationships”, which are the goals of this study.

Data analysis

All factors and items regarding students’ experiences were extracted from interview data, and then correspondent codes were created. The codes remained the meanings of the data. As the next step, we compared the coded data and made them more abstract to create categories and subcategories from the viewpoint of the four items of “development of the ability to consider patients holistically”, “self-understanding”, “development of supportive relationships” and “establishment of collaborative relationships”, which are the goals of this study. We ensure reliability and validity in the analysis by discussing similarities and differences repeatedly among qualitative researchers of psychiatric nurses to have a common view.

Ethical considerations

This study was approved by the Ethical Review Committee of the Japanese Red Cross Akita College of Nursing (Approval number: 2020-21). All participants provided written informed consent before participating in the study. The confidentiality of all participants was protected.

Results

Five sophomore participants engaged in the psychiatric nursing education program in this study. The average duration of interviews lasted 40 min (range 31–51 min). Table 3 shows that the examination of the experiences of these students involved in the psychiatric nursing education program, which aimed at fostering competency, resulted in the identification of 39 sub-categories and 19 categories.

Table 3. Experience of students who participated in psychiatric nursing educational program aiming at competency evelopment.

Item	Categories (19)	Subcategories (39)
Development of the ability to perceive the participant holistically	Acquisition of patient’s viewpoints	Efforts to decipher patients’ thoughts and feelings Understanding what is said and done from the patient’s point of view
	Acquisition of images of interacting with people with mental disabilities	Getting a better picture of the actual patient Better imagine the situation
	Recognition of the importance of a holistic view of the subject	Awareness of the relationship among physical, mental and society Process-focused understanding
Self-understanding	Awareness of egocentrism	One-way communication Preoccupied with the duties
	Feeling of not being able to face the patients	Self-awareness of being confused and rushed Self-awareness of covering up
	Finding their own challenges	Desire for relationships based on trust Awareness of communication challenges
Development of supportive relationships	Difficulty in interaction	Feeling at a loss as to how to respond Things doesn’t turn out the way expected
	Concerns about negative emotional expression	Concerns about unconsciously expressed emotions Negative reactions to emotional expression
	Perceived lack of breadth or depth of understanding	Inability to get to the heart of the matte Awareness of the narrowness of vision
	Striving for acceptance of the situation as it is	Avoiding easy encouragement Utilization of an empathetic approach Listening to people as they are
	Relief at finding connections	Calmness regained from a slight connection Approaching through empathy
	Realization of the importance of verbal and non-verbal communication	The importance of language expression The taste of silence
	Repeating trial and error	Trial and error to calm them down Trial and error to dispel gloomy feelings
	Recovery-oriented dialogue	Prioritizing patient’s strength Prioritizing patient’s dream and desire
	Realization of the importance of building a trusting relationship	Collaborative relationship with patients to solve problems Importance of relationship-building communication
Establishment of a collaborative relationships	Acquisition of diversity and multi-phase viewpoint	Awareness of diversity Awareness of multi-phase viewpoint
	Awareness of being a member of a team	Awareness of your strengths Awareness of their own roles
	Realization of broadening and deepening of horizons through working with others	Accepting the opinions of others Respecting the opinions of others
	Realization of the potential to make use of different opinions and values	Making use of everyone’s opinion Embracing different values

Regarding the four items of the goal, which are “development of the ability to consider patients holistically”, “self-understanding”, “development of supportive relationships” and “establishment of collaborative relationships”, categories, sub-categories, study participants’ comments, and side notes to their comments will show below as [ ], < >, italic and ( ), respectively. “Student A” identified as a patient in the results section, acted as a patient in the simulation.

Development of the ability to perceive the patient holistically

This consisted of 3 categories: [acquisition of patient’s viewpoints], [acquisition of images of interacting with people with mental disabilities] and [recognition of the importance of a holistic view of the patient].

In the scene of scenario 2 in which the patient answered that “I want to leave the hospital”, the student who portrayed a student nurse asked the patient, “Do you want to do something after you leave the hospital?” (The patient said) repeatedly.

‘I do not know what to do’, but I did not understand well because the patient wished to leave the hospital, but did not know what she wanted to do. I thought the patient did not want to leave the hospital and do anything. Instead, she wanted to prepare to leave the hospital and settle down. This indicated that the student made <efforts to decipher patients’ thoughts and feelings> by assuming that “the patient must be worried about the current situation and discharging procedures, but not about after discharge”. Furthermore, a student who played the patient in the same scenario said “I noticed that the patient was too preoccupied with herself to listen to others”. For example, if someone persists in asking a patient who is preoccupied with her concerns numerous questions because they want to know what the patient is thinking, In that case, I do not think the patient is mentally capable of responding. I understood that she wanted to get upset. This indicated <understanding what is said and done from the patient’s point of view>, considered as [acquisition of patient’s viewpoints].

Additionally, a student who had never interacted with people with mental disabilities mentioned that “I got to understand a little bit about what is really like”, which indicated < getting a better picture of the actual patient>. “It could have given us a better idea of the situation during assessment (of cases) to create detailed characters of an actual patient in the practice than just to imagine a patient”, which indicated <better imagine the situation> led to [acquisition of images of interacting with people with mental disabilities]. Students who completed the whole course also stated that “I understood the importance of the relationship between the psychological aspect, social aspect, and physical aspect, and the whole view of patients”, which indicated gaining <awareness of the relationship among physical, mental, and society>. Other students mentioned that “a holistic view of disease is required since it varies with time”, which is categorized in <process-focused understanding> and indicated [recognition of the importance of a holistic view of the patient].

Self-understanding

This consisted of 3 categories: [egocentrism awareness], [feeling unable to face patients], and [personal challenges]. In the scenario I mentioned, the student portrayed a student nurse bathing a patient and made an insightful observation. They recalled, “I only asked questions. While participating, I believed my communication with the patient was effective. During the reconstitution, I transcribed the conversation and realized I dominated while the patient’s responses remained minimal. This revealed my unidirectional, self-centered communication”. The student recognized their tendency towards <one-way communication> and <preoccupation with duties>, leading to “pushy suggestions” regarding the patient and a “controlling attitude”. This indicates the student’s [awareness of egocentrism].

The student who invited the patient to a rehabilitation program in scenario 2 mentioned that “The patient looked upset, saying ‘This is not the time to do this’. She suddenly changed her attitude. So, I was confused. What was I supposed to do? Did I do something wrong? I had no idea what to do”. The student said “I reviewed the situation (during the reconstitution) and realized that it had been too chaotic to understand the patient” indicating that the student experienced <self-awareness of being confused and rushed> in the interaction with the patient. The student who played a student nurse and had difficulty responding to the patient reviewed the situation, saying “there were many silent moments. I laughed it off to break the silence”, which indicated <self-awareness of covering up>. Each student reached to [feeling unable to face the patients].

In Scenario 1, a student nurse advised a patient to bathe but afterward “realized that building a relationship is the first step. Instead of instructing the patients to do anything, we should study their background and learn about them to foster a strong relationship”. The student expressed <a desire for trust-based relationships>. Another student noted that “I frequently asked the patient one-sided questions. I should have exhibited greater empathy by paying more attention to her feelings”, which is < awareness of communication challenges>. It was also a time of [discovering personal challenges].

Development of supportive relationships

This consisted of 9 categories: [difficulty in interaction], [concerns about negative emotional expression], [perceived lack of breadth or depth of understanding], [striving for acceptance of the situation as it is], [relief at finding connections], [realization of the importance of verbal and non-verbal communication], [repeating trial and error], [a recovery-oriented dialogue], [realization of the importance of building a trusting relationship].

The student said to the patient who had not taken a bath for more than 1 week in Scenario 1, “Do you have some concerns?” because the student thought the patient would have other diseases if she did not keep herself clean. However, the student got only a brief response of “Nothing” from the patient. The student mentioned that “I was confused. why she does not take (a bath)? Is it because of the disease? The more I thought, the more I got confused.”, which indicated <feeling at a loss as to how to respond>. In scenario 3, a student was at a loss for an answer when the patient repeatedly said “I have no reason to live”. The student listened to the patient’s feelings and then said to the patient cheerfully, “Something good will happen as long as you are alive. Is there something you like?” to motivate the patient. However, the student did not get the expected response from the patient. The student mentioned that “I realized that things would not turn out how I expected”. Only the patient knows how he/she feels. It is not easy to have their response, which indicated the student realized <things do not turn out how I expected> and felt [difficulty in interaction]. The student who did not get the response she expected from the patient in the simulation practice mentioned that “I could say something superficial to the patient. However, I was worried if I was showing my emotions on my face. Unreasonable words (from the patients) made me irritated, and I wondered if my emotions were on my face…”, which indicated she mentioned <concerns about unconsciously expressing emotions> from herself. Similarly, the student who participated in the simulation practice as an observer said “There were some situations in which student nurses were a little bit upset. I think patients can tell what nurses are thinking through their words and expressions; they presumably wonder why nurses tend to be blunt. It seems to make the distance between patients and nurses even further”, which indicated that the student had [concerns about negative emotional expression] by saying <negative reactions to emotional expression>. In scenario 3, one of the students said “The patient originally said she had no reason to live as it is, but I cannot pin down why the patient thought that way.”, which indicated that the student was going through the fact that she <inability to get to the heart of the matter> of the problems patients have and was aware <awareness of the narrowness of vision>. This means that the student dearth [of lack of breadth or depth of understanding was perceived]. However, in the same scene, another student tried not to give <avoiding easy encouragement> to the patients who repeated “there is no hope in life”. The student said “I believe that the patient will gradually open her mind to me as long as I keep an active listening, such as sitting next to the patient, listening attentively with nodding”. The student [strived to accept the situation as it is] through <approaching through empathy> and tried <utilization of an empathetic approach> saying “I am unsure. However, it is will be okay as long as I gradually acquire empathy from the patient since I believe that it will open her mind”. This indicated that the student felt <calmness regained from a slight connection> and [relief at finding connections] with the patient. The student who reviewed the interaction in the reconstitution mentioned <the importance of language expression> saying “There are many things I cannot express in words even though I want to talk about what I am having in mind. No matter how much I think ‘please understand’, I bet they will not understand”. During a discussion within the student team, one of the students said “Is not the meaningful silence important? I do not think we always have to use words to connect with patients”, which indicated that the student also acquired [realization of the importance of verbal and non-verbal communication]. Students did [repeating trial and error], such as trying to calm down the patient depending on the patient’s condition and [recovery-oriented dialogue], such as <prioritizing patient’s strength> and <prioritizing patient’s dream and desire>. The student said “once I became aware of (patient’s concerns) by listening to what they were being worried about, the patient tried to think together”, which indicated the student established <collaborative relationship with patients to solve problems> and acquired [realization of the importance of building a trusting relationship].

Establishment of collaborative relationships

This consisted of four categories: [acquisition of diversity and multi-phase viewpoint], [awareness of being a member of a team], [realization of broadening and deepening of horizons through working with others], [realization of the potential to make use of different opinions and values]. A student who had repeated discussions within her student team through the whole program mentioned <awareness of diversity> in understanding patients, saying “If I had to think all by myself, I would be able to reach only one conclusion. What the six students thought about the patient was totally different from each other”. The student who participated in the simulation as an observer said “There were some situations in which student nurses raised their voice emotionally, and had a stiff expression, which made me confused and I was confused ‘Why? Which is assuming the role of the patient?’. (I gave the student nurses the feedback that) they had become emotional; then the student nurses contemplated ‘Maybe?’. So, I noticed that they did not notice their communication habits”. This indicated that the student acquired <awareness of multi-phase viewpoint> and reach [acquisition of diversity and multi-phase viewpoint]. The student who got a positive evaluation in the feedback from her team members said “I did not expect that what I had researched and given opinions would lead to other people’s learning. I thought I should share what I know more proactively”, which indicated the student was aware <awareness of your strengths>. The student thought “I will share what I think at least, I have to share what I thought”, which indicated the student fostered [awareness of being a member of a team] through <awareness of their own roles>. During discussions with the team, a student said “If I worked only by myself. I would be worried if my decision was right, but my team members gave me feedback, which made me think that I had been right or that I should have done this. Feedback to other people was also useful to me”. That indicated that the student gained [an awareness of views broaden and deepen with a corporation with others] through <accepting the opinions of others> and <respecting the opinions of others>.

A student said “We will be able to interact with patients more effectively if we combine our best ideas”, which indicated the student mentioned <making use of everyone’s opinion>. Another student said “In the case of diseases, there is a rare chance to discuss since thoughts are almost the same between people. But, mental disorders, and thoughts are different between people. Once we get used to having discussions, it will be easy for us to accept others’ opinions even though opinions are different among the specialties”, which indicated that the student gained [realization of the potential to make use of different opinions and values].

Discussion

Students experiences in the psychiatric nursing education program

Analysis of students’ experiences in four items revealed 19 categories and 39 sub categories, including “Development of the ability to consider patients holistically”, “Self-understanding”, “Development of supportive relationships”, and “Establishment of collaborative relationships”, which are the goals of the psychiatric nursing education program.

A team is a group that consists of more than two people who interact with each other to achieve valuable common goals and purposes. Synergist effects are expected in team activities compared to the total activities of each individual⁷⁾. We focused on increasing students’ problem-solving and teamwork skills to develop competencies. Through team-based learning, students [gained broadening and deepening horizons], [the ability to use different opinions and values], more than fostered [acquisition of diversity and multi-phase viewpoint] and [awareness of being a team member], which were the original goals of this program. Students developed [awareness of egocentrism] as “self-understanding” and [felt unable to engage with patients], indicating [personal challenges]. Especially, [understanding the patient’s perspective] in “Developing the ability to perceive a subject holistically” is similar to perspective taking⁸⁾, which is an attempt to understand the patient’s perspective. Although students played the patient role, it was meaningful for them to consider patients’ perspectives.

The program’s four sessions focused on patient A. The difficulty was designed to become more complex as the scenario progressed, drawing students deeper into the program. At the beginning of the learning cycle, learners must acknowledge their inability to solve problems using their existing knowledge and experiences⁹⁾. Students were motivated to solve problems early in the learning cycle and develop proactive and autonomous problem-solving skills through repeated team discussions and teamwork. Matsushita believes that university learning should be both active and profound, fostering deep commitment to learning through experiences and presentations, leading to “both externalization and internalization of cognitive process” shaping students’ character. Therefore, it is important in classroom practices to create learning environments in which as many students as possible take a profound approach to getting involved in problems, such as having students “review” the learning assignments¹⁰⁾. Teachers’ attitudes also need to be evaluated since they work as facilitators who create useful classes without preventing students from being involved in solving problems with their free ideas. Students should learn to support patients, taking into account their feelings, physical pains, comfort, and discomfort based on their experience. Nursing requires understanding patients’ mental and physical conditions, which can be achieved by combining theoretical and practical learning¹¹⁾. This program used team-based learning and simulation methods. Students’ experiences foster self-awareness through team activities and repeated reviews of opinions, enhance preparedness for the psychiatric nursing practice, and contribute to competency development.

Challenges related to the education method of the psychiatric nursing education program aiming at competencies development

As for students’ experiences in “development of supportive relationships”, positive experiences were shown, such as acquiring [connections] with patients through [repeating trial and error], [recovery-oriented dialogue], [striving for acceptance of the situation as it is]. They gained [realization of the importance of verbal and non-verbal communication] and [realization of the importance of building a trusting relationship], which indicated that important factors for building trust relationships and developing supportive relationships were found. Similarly, a student mentioned [difficulty in interaction] and [concerns about negative emotional expression], which indicated that the use of feeling in nursing was confirmed. According to Miyamoto, one of the most difficult issues for nurses is regarding the standard practice of handling their feelings that are brought up in human relationships with patients¹²⁾. That is, if nurses try to hide their negative feelings to respect patients’ position, they will fail to understand patients’ feelings. Besides, controlling their feelings would cause compassion fatigue such as loss of emotion, lethargy, and anger¹³⁾, considered as critical health issues. Therefore, education approaches that allow students to freely express negative emotions should be considered. Teaching students to utilize emotions effectively might help medical workers and patients manage stress by relieving negative feelings and solving problems¹⁴⁾. Support is necessary for students to recognize that their emotional evaluations and expressions can improve patient understanding and foster supportive relationships during repeated reconstructions and reviews. The unique aspect of this study’s result is that students’ experiences were mainly influenced by reconstructive reviews. The consideration of psychological safety, ensuring students can express their opinions without affecting relationships within the team is also necessary¹⁵⁾. This allows them to share their opinions and achieve their goals. Studies indicate that reviewing nursing practice might help student gain supportive relationships and enhance their motivation to provide care, rather than focusing on mistakes¹²⁾.

Limitations of the study and further challenges

The limitation of this study is that it only included the experiences of five students. Because of the small sample size, the results may not be applicable to other students. Future challenges include: Searching for an effective development method aiming at competency development, such as lectures, exercises, and practices. Improving the program and evaluating the effects on education by the program.

Conclusion

We developed 19 categories and 39 sub-categories from the experiences of students who participated in the psychiatric nursing education program. Students gained [acquisition of diversity and multi-phase viewpoint] through discussions and holistically patient understanding, including [acquisition of patient’s viewpoints]. They developed supportive relationships through [trial and error], [accepted the situation], and developed self-awareness, including [egocentrism]. These experiences enhanced their preparedness for psychiatric nursing practices class and contributed to competency development. However, one student struggles to express negative emotions while building supportive relationships. This adds to the difficulty of using emotions in nursing practice. An educational approach encouraging children to express negative emotions is required.

Conflict of interest

This is a section to declare any potential conflicts of interest that could influence the study results.

Ethics approval and consent to participate

This study was approved by the Ethical Review Committee of the Japanese Red Cross Akita College of Nursing (Approval number: 2020-21). All participants provided written informed consent before participating in the study.

Authorship

MS conceived and designed the study, collected and analyzed the data, and wrote the manuscript. MK contributed to the study conception and design, data analysis, and manuscript writing. Both authors have read and approved the final manuscript.