psychiatric nurse critical thinking

How mental health nurses improve their critical thinking through problem-based learning

Affiliation.

• 1 Tsui-Mei Hung, MSN, is Nurse Supervisor, Nursing Department, Taipei City Hospital Songde Branch, and PhD Candidate, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taipei, Taiwan. Lee-Chun Tang, MSN, is Lecturer, Department of Nursing, Tzu Chi College of Technology, Hualien, and PhD Student, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan. Chen-Ju Ko, MSN, is Lecturer, Department of Nursing, Tzu Chi College of Technology, Hualien, and PhD Candidate, School of Nursing, National Yang Ming University, Taipei, Taiwan.
• PMID: 25993456
• DOI: 10.1097/NND.0000000000000167

Critical thinking has been regarded as one of the most important elements for nurses to improve quality of patient care. The aim of this study was to use problem-based learning (PBL) as a method in a continuing education program to evaluate nurses' critical thinking skills. A quasiexperimental study design was carried out. The "Critical Thinking Disposition Inventory" in Chinese was used for data collection. The results indicated significant improvement after PBL continuous education, notably in the dimensions of systematic analysis and curiosity. Content analysis extracted four themes: (a) changes in linear thinking required, (b) logical and systematic thinking required performance improved, (3) integration of prior knowledge and clinical application, and (4) brainstorming learning strategy. The study supports PBL as a continuing education strategy for mental health nurses, and that systematic analysis and curiosity effectively facilitate the development of critical thinking.

Publication types

• Research Support, Non-U.S. Gov't
• Education, Nursing, Continuing
• Educational Measurement
• Middle Aged
• Problem-Based Learning / methods*
• Program Evaluation
• Psychiatric Nursing / education*

The Value of Critical Thinking in Nursing

• How Nurses Use Critical Thinking
• How to Improve Critical Thinking
• Common Mistakes

Some experts describe a person’s ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking. Others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, and determine the relevance of information to a situation.

Nicholas McGowan, BSN, RN, CCRN, has been a critical care nurse for 10 years in neurological trauma nursing and cardiovascular and surgical intensive care. He defines critical thinking as “necessary for problem-solving and decision-making by healthcare providers. It is a process where people use a logical process to gather information and take purposeful action based on their evaluation.”

“This cognitive process is vital for excellent patient outcomes because it requires that nurses make clinical decisions utilizing a variety of different lenses, such as fairness, ethics, and evidence-based practice,” he says.

How Do Nurses Use Critical Thinking?

Successful nurses think beyond their assigned tasks to deliver excellent care for their patients. For example, a nurse might be tasked with changing a wound dressing, delivering medications, and monitoring vital signs during a shift. However, it requires critical thinking skills to understand how a difference in the wound may affect blood pressure and temperature and when those changes may require immediate medical intervention.

Nurses care for many patients during their shifts. Strong critical thinking skills are crucial when juggling various tasks so patient safety and care are not compromised.

Jenna Liphart Rhoads, Ph.D., RN, is a nurse educator with a clinical background in surgical-trauma adult critical care, where critical thinking and action were essential to the safety of her patients. She talks about examples of critical thinking in a healthcare environment, saying:

“Nurses must also critically think to determine which patient to see first, which medications to pass first, and the order in which to organize their day caring for patients. Patient conditions and environments are continually in flux, therefore nurses must constantly be evaluating and re-evaluating information they gather (assess) to keep their patients safe.”

The COVID-19 pandemic created hospital care situations where critical thinking was essential. It was expected of the nurses on the general floor and in intensive care units. Crystal Slaughter is an advanced practice nurse in the intensive care unit (ICU) and a nurse educator. She observed critical thinking throughout the pandemic as she watched intensive care nurses test the boundaries of previously held beliefs and master providing excellent care while preserving resources.

“Nurses are at the patient’s bedside and are often the first ones to detect issues. Then, the nurse needs to gather the appropriate subjective and objective data from the patient in order to frame a concise problem statement or question for the physician or advanced practice provider,” she explains.

Top 5 Ways Nurses Can Improve Critical Thinking Skills

We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.

Case-Based Approach

Slaughter is a fan of the case-based approach to learning critical thinking skills.

In much the same way a detective would approach a mystery, she mentors her students to ask questions about the situation that help determine the information they have and the information they need. “What is going on? What information am I missing? Can I get that information? What does that information mean for the patient? How quickly do I need to act?”

Consider forming a group and working with a mentor who can guide you through case studies. This provides you with a learner-centered environment in which you can analyze data to reach conclusions and develop communication, analytical, and collaborative skills with your colleagues.

Practice Self-Reflection

Rhoads is an advocate for self-reflection. “Nurses should reflect upon what went well or did not go well in their workday and identify areas of improvement or situations in which they should have reached out for help.” Self-reflection is a form of personal analysis to observe and evaluate situations and how you responded.

This gives you the opportunity to discover mistakes you may have made and to establish new behavior patterns that may help you make better decisions. You likely already do this. For example, after a disagreement or contentious meeting, you may go over the conversation in your head and think about ways you could have responded.

It’s important to go through the decisions you made during your day and determine if you should have gotten more information before acting or if you could have asked better questions.

During self-reflection, you may try thinking about the problem in reverse. This may not give you an immediate answer, but can help you see the situation with fresh eyes and a new perspective. How would the outcome of the day be different if you planned the dressing change in reverse with the assumption you would find a wound infection? How does this information change your plan for the next dressing change?

Develop a Questioning Mind

McGowan has learned that “critical thinking is a self-driven process. It isn’t something that can simply be taught. Rather, it is something that you practice and cultivate with experience. To develop critical thinking skills, you have to be curious and inquisitive.”

To gain critical thinking skills, you must undergo a purposeful process of learning strategies and using them consistently so they become a habit. One of those strategies is developing a questioning mind. Meaningful questions lead to useful answers and are at the core of critical thinking .

However, learning to ask insightful questions is a skill you must develop. Faced with staff and nursing shortages , declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than finish the task in front of you. Yet, questions drive active learning and train your brain to see the world differently and take nothing for granted.

It is easier to practice questioning in a non-stressful, quiet environment until it becomes a habit. Then, in the moment when your patient’s care depends on your ability to ask the right questions, you can be ready to rise to the occasion.

Practice Self-Awareness in the Moment

Critical thinking in nursing requires self-awareness and being present in the moment. During a hectic shift, it is easy to lose focus as you struggle to finish every task needed for your patients. Passing medication, changing dressings, and hanging intravenous lines all while trying to assess your patient’s mental and emotional status can affect your focus and how you manage stress as a nurse .

Staying present helps you to be proactive in your thinking and anticipate what might happen, such as bringing extra lubricant for a catheterization or extra gloves for a dressing change.

By staying present, you are also better able to practice active listening. This raises your assessment skills and gives you more information as a basis for your interventions and decisions.

Use a Process

As you are developing critical thinking skills, it can be helpful to use a process. For example:

• Ask questions.
• Gather information.
• Implement a strategy.
• Evaluate the results.
• Consider another point of view.

These are the fundamental steps of the nursing process (assess, diagnose, plan, implement, evaluate). The last step will help you overcome one of the common problems of critical thinking in nursing — personal bias.

Common Critical Thinking Pitfalls in Nursing

Your brain uses a set of processes to make inferences about what’s happening around you. In some cases, your unreliable biases can lead you down the wrong path. McGowan places personal biases at the top of his list of common pitfalls to critical thinking in nursing.

“We all form biases based on our own experiences. However, nurses have to learn to separate their own biases from each patient encounter to avoid making false assumptions that may interfere with their care,” he says. Successful critical thinkers accept they have personal biases and learn to look out for them. Awareness of your biases is the first step to understanding if your personal bias is contributing to the wrong decision.

New nurses may be overwhelmed by the transition from academics to clinical practice, leading to a task-oriented mindset and a common new nurse mistake ; this conflicts with critical thinking skills.

“Consider a patient whose blood pressure is low but who also needs to take a blood pressure medication at a scheduled time. A task-oriented nurse may provide the medication without regard for the patient’s blood pressure because medication administration is a task that must be completed,” Slaughter says. “A nurse employing critical thinking skills would address the low blood pressure, review the patient’s blood pressure history and trends, and potentially call the physician to discuss whether medication should be withheld.”

Fear and pride may also stand in the way of developing critical thinking skills. Your belief system and worldview provide comfort and guidance, but this can impede your judgment when you are faced with an individual whose belief system or cultural practices are not the same as yours. Fear or pride may prevent you from pursuing a line of questioning that would benefit the patient. Nurses with strong critical thinking skills exhibit:

• Learn from their mistakes and the mistakes of other nurses
• Look forward to integrating changes that improve patient care
• Treat each patient interaction as a part of a whole
• Evaluate new events based on past knowledge and adjust decision-making as needed
• Solve problems with their colleagues
• Are self-confident
• Acknowledge biases and seek to ensure these do not impact patient care

An Essential Skill for All Nurses

Critical thinking in nursing protects patient health and contributes to professional development and career advancement. Administrative and clinical nursing leaders are required to have strong critical thinking skills to be successful in their positions.

By using the strategies in this guide during your daily life and in your nursing role, you can intentionally improve your critical thinking abilities and be rewarded with better patient outcomes and potential career advancement.

Frequently Asked Questions About Critical Thinking in Nursing

How are critical thinking skills utilized in nursing practice.

Nursing practice utilizes critical thinking skills to provide the best care for patients. Often, the patient’s cause of pain or health issue is not immediately clear. Nursing professionals need to use their knowledge to determine what might be causing distress, collect vital information, and make quick decisions on how best to handle the situation.

How does nursing school develop critical thinking skills?

Nursing school gives students the knowledge professional nurses use to make important healthcare decisions for their patients. Students learn about diseases, anatomy, and physiology, and how to improve the patient’s overall well-being. Learners also participate in supervised clinical experiences, where they practice using their critical thinking skills to make decisions in professional settings.

Do only nurse managers use critical thinking?

Nurse managers certainly use critical thinking skills in their daily duties. But when working in a health setting, anyone giving care to patients uses their critical thinking skills. Everyone — including licensed practical nurses, registered nurses, and advanced nurse practitioners —needs to flex their critical thinking skills to make potentially life-saving decisions.

Meet Our Contributors

Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Crystal Slaughter is a core faculty member in Walden University’s RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized ICU patients and in inpatient palliative care. Slaughter’s clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.

Jenna Liphart Rhoads, Ph.D., RN

Jenna Liphart Rhoads is a nurse educator and freelance author and editor. She earned a BSN from Saint Francis Medical Center College of Nursing and an MS in nursing education from Northern Illinois University. Rhoads earned a Ph.D. in education with a concentration in nursing education from Capella University where she researched the moderation effects of emotional intelligence on the relationship of stress and GPA in military veteran nursing students. Her clinical background includes surgical-trauma adult critical care, interventional radiology procedures, and conscious sedation in adult and pediatric populations.

Nicholas McGowan, BSN, RN, CCRN

Nicholas McGowan is a critical care nurse with 10 years of experience in cardiovascular, surgical intensive care, and neurological trauma nursing. McGowan also has a background in education, leadership, and public speaking. He is an online learner who builds on his foundation of critical care nursing, which he uses directly at the bedside where he still practices. In addition, McGowan hosts an online course at Critical Care Academy where he helps nurses achieve critical care (CCRN) certification.

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Critical Thinking and Reflection for Mental Health Nursing Students

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The ability to reflect critically is a vital nursing skill. It will help your students to make better decisions, avoid errors, identify good and bad forms of practice and become better at learning from their experiences. The challenges they will face as a mental health nurse are complex so this book breaks things down to the foundations helping them to build critical thinking and reflection skills from the ground up.

Key features:

· Covers the theory and principles behind critical thinking and reflection

· Explores the specific mental health context and unique challenges students are likely to face as a mental health nurse

· Applies critical thinking to practice but also to academic study, showing how to demonstrate these skills in assignments

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Critical Thinking in Nursing

• First Online: 02 January 2023

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• Şefika Dilek Güven 3  

Part of the book series: Integrated Science ((IS,volume 12))

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Critical thinking is an integral part of nursing, especially in terms of professionalization and independent clinical decision-making. It is necessary to think critically to provide adequate, creative, and effective nursing care when making the right decisions for practices and care in the clinical setting and solving various ethical issues encountered. Nurses should develop their critical thinking skills so that they can analyze the problems of the current century, keep up with new developments and changes, cope with nursing problems they encounter, identify more complex patient care needs, provide more systematic care, give the most appropriate patient care in line with the education they have received, and make clinical decisions. The present chapter briefly examines critical thinking, how it relates to nursing, and which skills nurses need to develop as critical thinkers.

Graphical Abstract/Art Performance

Critical thinking in nursing.

This painting shows a nurse and how she is thinking critically. On the right side are the stages of critical thinking and on the left side, there are challenges that a nurse might face. The entire background is also painted in several colors to represent a kind of intellectual puzzle. It is made using colored pencils and markers.

(Adapted with permission from the Association of Science and Art (ASA), Universal Scientific Education and Research Network (USERN); Painting by Mahshad Naserpour).

Unless the individuals of a nation thinkers, the masses can be drawn in any direction. Mustafa Kemal Atatürk

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Güven, Ş.D. (2023). Critical Thinking in Nursing. In: Rezaei, N. (eds) Brain, Decision Making and Mental Health. Integrated Science, vol 12. Springer, Cham. https://doi.org/10.1007/978-3-031-15959-6_10

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What is Critical Thinking in Nursing? (With Examples, Importance, & How to Improve)

Successful nursing requires learning several skills used to communicate with patients, families, and healthcare teams. One of the most essential skills nurses must develop is the ability to demonstrate critical thinking. If you are a nurse, perhaps you have asked if there is a way to know how to improve critical thinking in nursing? As you read this article, you will learn what critical thinking in nursing is and why it is important. You will also find 18 simple tips to improve critical thinking in nursing and sample scenarios about how to apply critical thinking in your nursing career.

What Is Critical Thinking In Nursing?

4 reasons why critical thinking is so important in nursing, 1. critical thinking skills will help you anticipate and understand changes in your patient’s condition., 2. with strong critical thinking skills, you can make decisions about patient care that is most favorable for the patient and intended outcomes., 3. strong critical thinking skills in nursing can contribute to innovative improvements and professional development., 4. critical thinking skills in nursing contribute to rational decision-making, which improves patient outcomes., what are the 8 important attributes of excellent critical thinking in nursing, 1. the ability to interpret information:, 2. independent thought:, 3. impartiality:, 4. intuition:, 5. problem solving:, 6. flexibility:, 7. perseverance:, 8. integrity:, examples of poor critical thinking vs excellent critical thinking in nursing, 1. scenario: patient/caregiver interactions, poor critical thinking:, excellent critical thinking:, 2. scenario: improving patient care quality, 3. scenario: interdisciplinary collaboration, 4. scenario: precepting nursing students and other nurses, how to improve critical thinking in nursing, 1. demonstrate open-mindedness., 2. practice self-awareness., 3. avoid judgment., 4. eliminate personal biases., 5. do not be afraid to ask questions., 6. find an experienced mentor., 7. join professional nursing organizations., 8. establish a routine of self-reflection., 9. utilize the chain of command., 10. determine the significance of data and decide if it is sufficient for decision-making., 11. volunteer for leadership positions or opportunities., 12. use previous facts and experiences to help develop stronger critical thinking skills in nursing., 13. establish priorities., 14. trust your knowledge and be confident in your abilities., 15. be curious about everything., 16. practice fair-mindedness., 17. learn the value of intellectual humility., 18. never stop learning., 4 consequences of poor critical thinking in nursing, 1. the most significant risk associated with poor critical thinking in nursing is inadequate patient care., 2. failure to recognize changes in patient status:, 3. lack of effective critical thinking in nursing can impact the cost of healthcare., 4. lack of critical thinking skills in nursing can cause a breakdown in communication within the interdisciplinary team., useful resources to improve critical thinking in nursing, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. will lack of critical thinking impact my nursing career, 2. usually, how long does it take for a nurse to improve their critical thinking skills, 3. do all types of nurses require excellent critical thinking skills, 4. how can i assess my critical thinking skills in nursing.

• Ask relevant questions • Justify opinions • Address and evaluate multiple points of view • Explain assumptions and reasons related to your choice of patient care options

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The characteristic that distinguishes a professional nurse is cognitive rather than psychomotor ability. Nursing practice demands that practitioners display sound judgement and decision-making skills as critical thinking and clinical decision making is an essential component of nursing practice. Nurses’ ability to recognize and respond to signs of patient deterioration in a timely manner plays a pivotal role in patient outcomes (Purling & King 2012). Errors in clinical judgement and decision making are said to account for more than half of adverse clinical events (Tomlinson, 2015). The focus of the nurse clinical judgement has to be on quality evidence based care delivery, therefore, observational and reasoning skills will result in sound, reliable, clinical judgements. Clinical judgement, a concept which is critical to the nursing can be complex, because the nurse is required to use observation skills, identify relevant information, to identify the relationships among given elements through reasoning and judgement. Clinical reasoning is the process by which nurses observe patients status, process the information, come to an understanding of the patient problem, plan and implement interventions, evaluate outcomes, with reflection and learning from the process (Levett-Jones et al, 2010). At all times, nurses are responsible for their actions and are accountable for nursing judgment and action or inaction.

The speed and ability by which the nurses make sound clinical judgement is affected by their experience. Novice nurses may find this process difficult, whereas the experienced nurse should rely on her intuition, followed by fast action. Therefore education must begin at the undergraduate level to develop students’ critical thinking and clinical reasoning skills. Clinical reasoning is a learnt skill requiring determination and active engagement in deliberate practice design to improve performance. In order to acquire such skills, students need to develop critical thinking ability, as well as an understanding of how judgements and decisions are reached in complex healthcare environments.

As lifelong learners, nurses are constantly accumulating more knowledge, expertise, and experience, and it’s a rare nurse indeed who chooses to not apply his or her mind towards the goal of constant learning and professional growth. Institute of Medicine (IOM) report on the Future of Nursing, stated, that nurses must continue their education and engage in lifelong learning to gain the needed competencies for practice. American Nurses Association (ANA), Scope and Standards of Practice requires a nurse to remain involved in continuous learning and strengthening individual practice (p.26)

Alfaro-LeFevre, R. (2009). Critical thinking and clinical judgement: A practical approach to outcome-focused thinking. (4th ed.). St Louis: Elsevier

The future of nursing: Leading change, advancing health, (2010). https://campaignforaction.org/resource/future-nursing-iom-report

Levett-Jones, T., Hoffman, K. Dempsey, Y. Jeong, S., Noble, D., Norton, C., Roche, J., & Hickey, N. (2010). The ‘five rights’ of clinical reasoning: an educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Education Today. 30(6), 515-520.

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Purling A. & King L. (2012). A literature review: graduate nurses’ preparedness for recognising and responding to the deteriorating patient. Journal of Clinical Nursing, 21(23–24), 3451–3465

Thompson, C., Aitken, l., Doran, D., Dowing, D. (2013). An agenda for clinical decision making and judgement in nursing research and education. International Journal of Nursing Studies, 50 (12), 1720 - 1726 Tomlinson, J. (2015). Using clinical supervision to improve the quality and safety of patient care: a response to Berwick and Francis. BMC Medical Education, 15(103)

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Assessing perceptions about critical thinking, motivation learning strategies in online psychiatric and mental health nursing education among Egyptian and Saudi undergraduate nursing students

• Nora Ghalib AlOtaibi 1 ,
• Amira Alshowkan 1 ,
• Neama Kamel 1 ,
• Ayman Mohamed El-Ashry 3 ,
• Nagla Saleh AlSaleh 1 &
• Eman Sameh Abd Elhay 2  

BMC Nursing volume  22 , Article number:  112 ( 2023 ) Cite this article

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The pandemic context prompts nursing students to be involved in online learning. Researchers indicated that critical thinking develops through the learning process, but the link between critical thinking and online learning in nursing does not have sufficient evidence.

Aim of Study

This research examines student perceptions about critical thinking, motivation, and learning strategies in online psychiatric nursing education among nursing students at Imam Abdulrahman bin Faisal University in Saudi Arabia and Alexandria University in Egypt.

Subject and Methods

An online survey was designed to collect data anonymously. A total of 75 Saudi undergraduates and 105 Egyptian nursing students who met the inclusion criteria participated. The online survey assessed three parts: socio-demographic data, critical thinking motivational, and cognitive processing strategy scales.

The current study found that using a motivating method for online learning inspired students to engage in critical thinking and cognitive processing strategies in a psychiatric and mental health nursing course, even in two different contexts.

This study demonstrates that using motivational methods for online learning encourages students to engage in critical thinking and cognitive processing strategies in psychiatry and mental health care courses, even in two different settings.

Peer Review reports

COVID-19 has a global impact on education; learning has been disrupted in several institutions, most notably nursing colleges in Saudi Arabia and Egypt. Conventional in-person classes had to be suspended to maintain the welfare of all students, teaching faculty, and patients [ 1 , 2 ]. In response to the pandemic, more than 170 countries now rely on online learning [ 3 ]. As a result, the psychiatric nursing course has been taught virtually at Imam Abdulrahman and Alexandria University. In psychiatric nursing curricula, nurses must be able to think critically to carry out complex nursing actions that affect patient safety and satisfaction [ 4 ].

The pandemic context prompts nursing students to address different approaches to learning strategies used by educational institutions to take full advantage of the learning experience by getting students involved in this new virtual learning setting [ 5 ]. Critical thinking is “the act of formulating a reflective judgment about what to believe or what is the priority action based on specific situations” [ 6 ]. It’s crucial to be mastered by nursing students [ 7 , 8 ].

In the literature, critical thinking (CT) can be traced back to 1965 in nursing education, but it became more prominent in the 1980s as researchers endeavored to understand CT in nursing education. The use of CT during online nursing education was closely investigated in the 1990s as a result of the development of online modes, such as electronic learning systems and online audiovisual programs, which allowed students and teachers to interact as if they were in a real-world setting [ 9 , 10 ]. CT is the method of self-regulatory decision-making with intent [ 11 ]. Interactive interpretation, presumption, analysis, and assessment are rationally regarded as part of the logical thinking process [ 11 ]. People are directed to make centering and informed decisions based on their beliefs using this approach [ 11 , 12 ]. The foundation of professional judgment is known as CT [ 13 ]. For nurses to correctly assess nursing diagnoses, CT skills are necessary because accurate analysis of patient data can be difficult. After all, high levels of thinking and intellect are needed; the thinking skills of nurses differ and can be enhanced, and the best use of CT abilities encourages the validity of the diagnosis based on the evidence used in research [ 14 ]. Several studies reported the importance of the use of critical thinking in psychiatric and mental health nursing [ 15 , 16 ]. For example, the use of well-designed simulations in psychiatric and mental health nursing education was found to enhance students’ critical thinking, decision-making, and communication skills [ 17 ]. Therefore, this study will enhance the previous studies regarding the importance of the use of critical thinking during online education.

Online learning refers to using cyberspace to reach educational resources and interact with the content, teachers, and other pupils. It helps students and instructors interact during the learning session to obtain information and build personal meaning [ 18 ]. Nurse educators play a vital role in identifying and implementing learning modifications in acquiring CT, besides focusing on innovative methods of teaching [ 19 ]. Since 2013, CT research focusing on the use of online education for psychiatric nursing has been infrequent and vague, as some studies focus on online education while others use blended methods with little evidence of their effectiveness [ 20 , 21 ]. Even though there have been several systematic reviews on CT in the field of nursing studies, only a tiny number have focused on the concepts and approaches for instructors to improve online technology utilization [ 19 ]. Furthermore, it has been reported that there needs to be more research on the predictors of CT, not only in online nursing education but also in nursing education in general [ 22 ].

The academic motivation was identified as an inherent and persistent desire of the learner to investigate new concepts [ 23 ]. There are three domains of academic motivation which are intrinsic and extrinsic motivation and lack of motivation which has been proven related to self-learning of students [ 24 , 25 , 26 ]. In nursing students, academic motivation has been studied and showed that motivational strategies are the most important elements that enhance student self-learning skills [ 27 , 28 ]. However, no published research was found to focus on the motivation strategies in psychiatric and mental health nursing during online teaching, so, this research will help to fill in the gap in this regard.

Strategies of online learning in form of self-directed learning skills and motivational approaches were used widely and proved to be effective. The use of self-directed strategies was established to enhance students learning autonomy to meet any changes in learning setting [ 29 ]. This strategy of learning enhances students’ thinking ability and self-management which was used during online education [ 30 , 31 ]. For instance, during the COVID-19 epidemic, self-directed learning, and motivational learning strategies among 1187 nursing students from Saudi Arabia, the Philippines, and Thailand were examined and found that the predictors of nursing students’ self-learning were the intrinsic motivation [ 32 ].

Critical thinking is essential in clinical nursing and a core part of an online nursing education program because it can help students learn more than traditional classroom teaching can [ 33 , 34 ]. According to Salyers et al. (2014), students are looking for ways to better incorporate technology into education as they become more technologically savvy [ 35 ]. According to Guri-Rosenblit, (2014), several online technologies used to aid the development of higher-order thinking skills in nursing education are used primarily to provide lectures and discussion groups rather than as the primary educational medium that would enhance CT [ 36 ]. It is worth noting that student’s perception of constructivist learning environments was related to critical thinking self-management strategies [ 37 ].

Researchers indicated that CT develops through the learning process, but the link between CT and online learning in nursing does not have sufficient evidence [ 33 , 38 ]. While the literature agreed that CT could occur in an online environment, more current research on the outcomes of online learning as they relate to the CT process is needed, as this has implications for its future use in nursing education [ 20 , 21 ]. However, it has been reported that the traditional educational approach impedes the development of CT skills, such as classroom teaching and the instructor-student power dynamic [ 19 ]. On the other hand, Gould et al. (2014) recommended that nursing online education and learning have definitely improved students’ learning and ability to gain CT and nursing competency, in addition to improving student satisfaction concerning accessibility and the capability to work remotely [ 39 ]. Lahti et al. (2014) also revealed that e-learning might help students gain knowledge and skills more quickly than face-to-face, teacher-centered methods [ 40 ].

The flexibility of online education for students and instructors has been studied. The positive aspect of learning has been reported as it provides flexibility in the use of different educational strategies, time, duration, and space conveniences, quick access for both instructors and students, and enhances the profound learning experience [ 35 , 41 , 42 ]. In addition, online learning stimulates student-centered learning, as the student manages online courses efficiently, which improves knowledge gain; self-efficacy, enhances performance, fosters CT, and enhances writing skills for the majority of students [ 43 , 44 ].

As a result of the coronavirus pandemic (COVID-19), governments released decrees on quarantine, social distancing, and staying at home; therefore, colleges and universities worldwide were closed [ 45 ]. COVID-19 has imposed education schemes worldwide to use alternatives for teaching and learning [ 46 ]. As a result, during the extraordinary COVID-19 outbreak, online distance learning programs were the only available mode of education [ 47 , 48 , 49 ]. Therefore, IAU, Alexandria University, and its College of Nursing have been involved in developing dynamic and contemporary online clinical curricula by applying CT and solving clinical problems.

In Saudi Arabia and Egypt, online modalities in clinical and mental health nursing are still relatively new. Since then, no research has been done on the usefulness of learning approaches for improving CT abilities that aid student’ professional problem-solving abilities [ 50 , 51 ]. As a result, this study aims to evaluate students’ attitudes toward critical thinking, motivation, and learning strategies in online psychiatric and mental health nursing education at Imam Abdulrahman Bin Faisal University in Saudi Arabia and Alexandria University in Egypt.

Study design and setting

A comparative cross-sectional research design was conducted among nursing students registered to take the Psychiatric Nursing and Mental Health course between Imam Abdulrahman Bin Faisal University (IAU) in Saudi Arabia and Alexandria University in Egypt. All nursing students were registered in the Psychiatric Nursing and Mental Health course for 2021–2022. The Psychiatric Nursing and Mental Health course was taught through 6 credit hours (3 h theatrical and 3 h clinical) in both universities. Both universities taught the same course description based on the same National Academic Reference Standard (NARS), with the primary focus being the integration of knowledge and skills to provide high-quality nursing management to clients with emotional and psychiatric problems in various healthcare settings. Clients with various mental disorders and their families will receive high-quality, secure home health care. Emphasis will be placed on the fundamental understanding of the mental illness concept, mental disorder classification, clinical illustrations, critical thinking, and treatment options. The course covers ideas about the nursing process, which serve as a framework for the psychiatric nursing care plan. Additionally, the course aims to assist students in promoting mental health, recognizing and preventing mental illness, and participating in mental health restoration [ 52 , 53 ].

Participants: sample size calculation and sampling technique

Based on data from literature Charan, & Biswas, )2013) [ 54 ], considering level of significance of 5%, and power of study of 80%, and based on data from literature, the sample size can be calculated using the following formula:

Where, Z 1-α/2 = is the standard normal variate, at 5% type 1 error it is 1.96, SD = standard deviation of variable and d = absolute error or precision. So,

Based on the above formula, the sample size required for the study is 180.

All participants were chosen conveniently. A total of 75 Saudi undergraduate students responded out of 115 with a response rate of 65.2%, and 105 Egyptian undergraduate students responded out of 140 with a response rate of 75% (Fig.  1 ) . Finally, 180 nursing students representing two distinct countries and universities (IAU) in Saudi Arabia and Alexandria University in Egypt produced sufficiently detailed responses to be included in the study. The Psychiatric and Mental Health Nursing course was taught in English. The following criteria were used to determine the inclusion of the studied subject: Enrolled in psychiatric and mental health nursing at both IAU and Alexandria Universities in the second semester of the academic year 2021–2022 and willing to be involved in the study.

Participants’ Recruitment Process Flow Chart

Data collection

The researchers used a three-section-based questionnaire for data collection. Part 1 includes the socio-demographic data which includes the following questions: gender, marital status, age, university, which nursing course the student is studying, current GPA, hours of study, and if the student was transferred from another college or university ( supplementary file ).

Part 2 includes Critical thinking motivation scale and The Cognitive Processing Strategies Scale

Critical thinking motivation scale (ctms) (english version).

It was developed by Valenzuela et al., 2011. The scale is based on a theoretical option that gives the perspective of motives primacy over the perspective of attitudes, with the aim of acquiring insight into students’ motivation levels and determining the specific component that influences their performance. [ 55 ]. CTMS measures the different components of motivation with respect to critical thinking. This scale contains 19 items on a 6-point Likert scale that allow participants to express their level of agreement or disagreement with a set of statements relating to each participant’s expectations of thinking in a critical or rigorous manner (expectation) and the importance (value) of thinking in this manner. The rest of the statements are about the value and utility (utility) they notice in thinking, the cost they are willing to take for thinking in that way thoroughly, and the interest this method of thinking arouses in them. The reliability for the scale is 0.77, and the validity has shown a significant correlation (r = 0.50–0.57) between motivation and critical thinking [ 55 ]. The Cronbach’s alpha reliability estimate in the present study was 0.912.

The cognitive Processing Strategies Scale (CPSS) (English version)

It was a modified version of the Motivated Strategies for Learning Questionnaire (MSLQ) of Pintrich’s instrument. Pintrich et al. (1991) proposed five sub-scales (i.e., rehearsal (REH), elaboration (ELA), organization (ORG), critical thinking (CT), and metacognitive self-regulation (MSR); it had 31 items, each item on a seven-point Likert scale [ 56 ]. Compared with the original MSLQ, the 18-item Cognitive Processing Strategies Scale modified by Professor Jiling Liu in 2019 has a different aim: to improve equivalence and efficiency in measuring cognitive and motivational learning processes by using more cost-effective analytical procedures and minimizing the number of tests taken. The scale has 18 items on a 7-point Likert-type scale with scores ranging from 1 to 7, and the statement “When I study for this class, I practice saying the materials to myself over and over” has a score of 1 for not at all true of me and a score of 7 for very true of me. The modified scale of the Cognitive Processing Strategies Scale (CPSS) proposed five sub-scales like the original one: rehearsal (REH), represented by 2 items; elaboration (ELA), represented by 7 items; organization (ORG), represented by 2 items; critical thinking (CT), represented by 6 items; and general cognitive strategies (GCS), represented by 13 items. A lot of items had bi-factor and tri-factor categories in the subscales. The scale’s validity is 0.892, and the reliability is 0.825 [ 57 ]. In addition, Cronbach’s alpha reliability estimate in the present study was 0.892.

Ethical approval

This study was approved by institution review board of Imam Abdulrahman Bin Faisal University (IAU) research Ethical Committee for the study settings to gather the necessary data (11/2022). The study’s goal was communicated to the participating nursing students through their official emails. Every student was informed that they had the right to decline participation or quit at any time before finishing the study materials without repercussions. Nursing students who agreed to participate in the study provided electronic, signed, informed consent. The concept of anonymity was honored. During the study, data privacy was guaranteed.

Data collection phase

Official permissions from the faculty of nursing IAU and Alexandria University were obtained to conduct the study. A list of the official emails of all enrolled nursing students at the psychiatric and mental health nursing course from the registration desk was obtained. The questionnaire link was sent individually to every student official university emails. It was worse mentioned that the email of nursing students was linked with national identifier.The nursing students who clicked the link were directed to the Microsoft Office Forms. To minimize the missing data, the participants were requested to fill in all items in the online questionnaire or else they could not proceed to the next page; a notification box indicated a warning note that one or more items were not answered. On completion of the questionnaire, the participant was directed to click the submit option, and finally, the online questionnaire was sent to the drive.

A pilot study was conducted to evaluate the applicability, clarity, and usefulness of the study tools. The test was administered to 30 nursing students who were not research participants. The results of the pilot showed that no modifications were required. The Alpha Cronbach’s test, which was used to evaluate the internal consistency of the research instruments, indicated that the study tools had excellent reliability. Moreover, the information was gathered at the end of semester 2021/2022.

Psychiatric and mental health nursing courses are offered in an online education mode even after the era of COVID-19.The online education modality was formed in both universities on the Blackboard platform, Zoom, and Microsoft Teams, where academic materials and assignments were posted and class activities could be completed. Reference, guidance, and effective communication were available to students. The online course content was given weekly and had the same objectives and outline as the traditional face-to-face content, but the delivery mode was different. Before starting the course, the course coordinators prepared the time plan, the schedule of theory lectures, and all teaching materials and posted them on the blackboard. First, each rotation’s objectives, time plan, and rubrics were posted on the board as a pdf file to give the students holistic information about the rotation. Secondly, the theory lecture schedule list was posted to the platform as a PDF document. Finally, all lectures were uploaded as PowerPoint files, with assignments for each lecture, videos, and references.

Statistical analysis

Comparing the socio-demographic features of the students at IAU University and Alexandria University necessitated the analysis of demographic data using the percent (%) and chi test. The statistical analysis was conducted using SPSS V.24 (IBM Corp., Armonk, NY). To accurately describe the data, descriptive statistics revealed that the average values of continuous variables produced the correct results. Furthermore, the Critical Thinking Motivational Subdomains Scale was compared using the mean and standard deviation. The correlation coefficient was employed to compare the critical thinking motivating scale with the student assessments of the cognitive processing techniques scale. Moreover, the T- and ANOVA tests were utilized to demonstrate the connection between the students’ socio-demographic characteristics and the Critical Thinking Motivational Domains subscale. The dependability of the scale was assessed using an internal consistency and reliability test.

Table  1 shows the comparison of the socio-demographic characteristics of the students at IAU and Alexandria University: Of the 180 students surveyed, 75 were from IAU and 105 were from Alexandria University. The age range of the participants was 20 to 23 years. (69.3% and 81.0%) of IAU and Alexandria students were female, respectively. The majority of them (85.3 and 90.5%) were not married. As for GPA, (78.7%) obtained a 3.6–4.5 from IAU students, while (87.6%) of students obtained a 3.6 or less from Alexandria University. Approximately half (50.7% and 53.3%) of students reported studying 3–4 h a day. And most of them have not transferred from another university or college to the faculty of nursing. In terms of age and GPA, there is a significant difference between students at IAU University and Alexandria University (p = < 0.001**).

Test of normality

Table  2 shows the normality test of the critical thinking motivational scale and student perception of the cognitive processing strategies scale. The table revealed that the test of normality by Shapiro-Wilk value was insignificant, which reflects that it is reasonable to behave as if the data set is (sufficiently close to being) normally distributed.

Comparison of the critical thinking motivational scale domains

Table  3 compares the averages of the Critical Thinking Motivational Scale domains. According to the data in Table  2 , the mean IAU score in the expectancy and cost domains is (4.2) and (4.6), respectively, higher than the mean score of Alexandria University (4.0) and (4.5). However, these differences don’t reach a statistically significant level. It also appears from the table’s data that the mean IAU score according to attainment domain, utility domain, and interest domain (5.1), (5.2), and (5.1) is less than the mean score among Alexandria University (5.2), (5.4), and (5.2). However, these differences don’t reach a statistically significant level.

Comparison of the student perceptions about cognitive processing strategies

The results of the T-test from Table  4 show the number and distribution of student perceptions about cognitive processing strategies between IAU and Alexandria University. In the IAU, the mean total score of items was (92.1 ± 22.5). It is less than the mean total score of items at Alexandria University (94.1 ± 18.5), and the result of the t-test (0.636) came with a probability value of (0.526) more significant than the significance level (0.05), and accordingly, there are no significant differences.

Correlations among critical thinking motivational scale score and the student perception of cognitive processing strategies, Imam Abdulrahman bin Faisal University

As shown in Fig.  2 , the Critical Thinking Motivational Scale Score is significantly correlated with the student perception of cognitive processing strategies as measured by the correlation coefficient (0.597) at the significance level of < 0.001. This correlation suggests that students with higher levels of critical thinking motivation are more likely to perceive that they use cognitive processing strategies when studying.

Correlation between Critical thinking motivational scale and student perceptions about Cognitive processing strategies faculty of nursing, Imam Abdulrahman bin Faisal University

Correlations among critical thinking motivational scale score and the student perception of cognitive processing strategies, Alexandria University

It is clear from Fig.  3 that there is a positive correlation between the critical thinking motivational scale and student perceptions of cognitive processing strategies, scaling the Alexandria University correlation coefficient function value (0.513) to a significance level of < 0.001. This suggests that when students perceive themselves to be more motivated to engage in critical thinking, they are more likely to use effective cognitive processing strategies.

Correlation between Critical thinking motivational scale and student perceptions about Cognitive processing strategies faculty of nursing, Alexandria University

Relationships between socio-demographic characteristics of the students and student perceptions about cognitive processing strategies Scale, IAU and Alexandria University

T-Test and ANOVA results from Table  5 revealed an association between IAU students that how many hours a day do you spend studying and Critical Thinking Motivational Scale Domains Average (6.027, p = < 0.001). Specifically, the results showed that IAU students who are spent more hours studying, they had a higher average on the Critical Thinking Motivational Scale Domains.

Relationships between socio-demographic characteristics of the students and critical thinking motivational scale domains average, IAU and Alexandria University

T-test and ANOVA result from Table  6 revealed an association between the Alexandria University students transferring from another university or college into the nursing program and their perceptions of the Cognitive Processing Strategies Scale (2.130, p = 0.036). These results indicate that students’ transfers from another university or college to the nursing program affect their perceptions of cognitive processing approaches.

A nurse’s competency involves various components, such as academic concepts, professional judgment, a combination of skills, moral and ethical values, and the synthesis of all elements to define holism [ 23 ]. Educating students on thinking critically has become a crucial issue in today’s environment and has been represented as one of the core educational goals. Competence-based learning allows the incorporation of functionalist, behaviorist, and constructivist learning theories. Constructivist curricula attempt to allow students to learn new knowledge using their mental processes and in light of their previous learning experiences. As a result, students are expected to acquire questioning and thinking skills while learning [ 58 ]. Coronavirus (COVID-19) has caused chaos in educational systems worldwide. It resulted in a succession of pedagogical reforms that presented both opportunities and risks to educational quality [ 59 ]. So the present study aimed to assess students’ perceptions about critical thinking as well as the impact on motivation and learning strategies in the online psychiatric and mental health nursing program among Egyptian and Saudi undergraduates.

It can be noticed that both Egyptian and Saudi undergraduates displayed high mean scores in different subdomains of critical thinking motivation. The evidence suggests that students’ perceptions of critical thinking motivation were similar in the two cultures. It includes the expectations that all participants have about critical thinking (expectancy), the value of this skill (attainment), the benefit of using that skill (utility), how much I care and love to use that skill (interest), and their willingness to put time and effort into using that skill (cost domain). Furthermore, comparing both studied subjects revealed no statistically significant difference between them. This may be because teaching a psychiatric and mental health nursing course heavily depends on simulating reality by using different vignettes and case studies and urging students to discuss and interact by reflecting on their learning experiences and giving narrative feedback. Thus, this increased the students’ level of critical thinking, even if teaching was done online [ 60 ].

The same was reported by Guise et al., (2012), who indicated that the simulation type is well-suited to fostering critical thinking, communication, and decision-making skills in mental health nurses. It is also said that it is well-suited to e-learning and mixed-learning environments and is an excellent tool for multilingual simulations [ 61 ]. Similarly, it was found in different studies [ 62 , 63 ]. The expansion of online courses in universities, partly due to the COVID-19 epidemic, has created a new environment for learning, allowing students to complete course-related work at their leisure and in their preferred location. This new setting may be beneficial or troublesome, depending on students’ motivation and ability to self-regulate their learning [ 64 ]. With the current epidemic states of COVID-19 raising the need for online psychiatric and mental health nursing, IAU college professors have been charged with developing dynamic and contemporary online clinical curricula by applying critical thinking and solving clinical problems. The course coordinators have worked on increasing the interaction and engagement of students, even if it was online, by making a link between the goals and future expectations. The anticipation and management of emotions are considered critical elements of success in an educational system, and teachers emphasize the importance of adopting a new mode in an educational system. This may also be due to the opportunities given to students to construct different alternatives to stimulate the natural environment.

There is a strong relationship between research competencies, age, and nursing research course grades. Grande et al., 2021, used a CBE approach to investigate the predictors and associations of Saudi nursing students’ research competencies. The majority of nursing students were already familiar with the nursing research process. Nursing research competency was significantly predicted by age and nursing research course grades (A+/A). As a result, students with A + or A grades were three times more likely to be competent than those with lower grades. Similarly, nursing students over 20 are twice as likely as those under 20 to be competent in research [ 23 ].

The present study also revealed that students displayed a high mean score in different cognitive processing strategies, including when I study for this class, I repeat the materials to myself several times. I make lists of essential items for this class and memorize the lists. When I study for this class, I gather information from different sources, such as lectures, readings, and discussions. I relate the materials to what I already know when studying for this class. When I study for this class, I write brief summaries of the main ideas from the materials and my class notes. I try to understand this class’s materials by connecting the readings and the concepts from the lectures. I apply ideas from other class activities, such as lectures and discussions. I make simple charts, diagrams, or tables to help me organize class materials. When I study for this class, I review my class notes and outline essential concepts. I often question things I hear or read in this class to decide if I find them convincing.

Furthermore, they reflect the use of cognitive processing strategies concerning a theory or conclusion when presented in class or in the readings, making decisions with supporting evidence, developing their own ideas, and so on. Fajari, (2020) studied students’ critical thinking abilities and the impact of learning motivation on critical thinking skills [ 65 ]. The findings of this study revealed that learning motivation has an impact on critical thinking abilities. Students’ critical thinking skills improve as their motivation to learn increases.

The modes of learning and instructing have a direct impact on each other. Three distinct learning styles affect learners’ cognitive information in eight aspects: the alignment of learners’ liberal and conservative values. Loyens, Rikers, & Schmidt, (2008) examined the relationship between students’ conceptions of constructivist learning and their regulation and processing strategies. They examined the relationship between students’ perceptions of constructivist learning and their regulation and processing strategies [ 66 ]. The findings revealed that constructivist learning and regulations, as well as processing techniques, have structural relationships. Furthermore, students who are unsure of their learning abilities are more likely to select an ineffective regulating strategy.

Generally, the present study finding may be explained by several aspects, including the students’ accustomedness to this system in teaching since the occurrence of the Corona pandemic, or it may be attributed to the efficiency of the performance of faculty members in the online teaching classroom management, having gone through the actual experience. This is in addition to the work of universities to develop the capabilities of faculty, staff, and students in managing the new requirement, not only because of the pandemic but also because this is in line with the needs of the new labor market requirement. In closing, combining online learning with a motivational approach to students will encourage participants to actively engage in critical thinking and cognitive processing processes.

This study found that using a motivating method for online learning inspired students to engage in critical thinking and cognitive processing strategies in a psychiatric and mental health nursing course, even in two different contexts.

Limitations of the study

The sample of this study was limited in number because it was obtained from nursing students in specific nursing colleges at Imam Abdulrahman Bin Faisal University in Saudi Arabia and Alexandria University in Egypt who undertook a specific psychiatric and mental health nursing course. The results obtained from this study may not apply to students studying different online nursing courses. Furthermore, this quantitative study does not help us better understand students` perceptions of critical thinking, motivation, and learning strategies in online psychiatric and mental health nursing education. In the future, it can be further improved by adding qualitative research.

Recommendation

The recommendations for future study should broaden the subject by including more areas, more significant samples, and additional baccalaureate nursing programs. In addition, more investigation is required into how online learning experiences are perceived by both learners and educators and how this impacts how higher-level reasoning is developed in psychiatric nursing students. Several evaluations throughout the four-year nursing curriculum and the retention of critical thinking data by individual students would enable the monitoring of longitudinal developmental trends, individually and collectively, by class, gender, or any other crucial student factors.

Implication in nursing practices

This research was one of the few distinctive areas of psychiatric nursing education. Because there is a lack of broad agreement about the progress and assessment of students’ perceptions of critical thinking and motivation learning strategies in this course because there are no evidence-based best practices for online learning, conventional ways of teaching psychiatric nursing have persisted, possibly failing to meet the demands of today’s technologically aware psychiatric nursing students in the future. Additionally, there is a need for a more recent study on online learning’s efficacy regarding the growth of critical thinking abilities and motivation through the use of online modalities in different nursing courses.

Data Availability

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

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Acknowledgements

Our sincere thanks go to all participants of the study.

This research received no funds from the government, the corporate sector, or the non-profit sector.

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Department of Community Nursing, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

Nora Ghalib AlOtaibi, Amira Alshowkan, Neama Kamel & Nagla Saleh AlSaleh

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Amira alshowkan: Conceptualization, preparation, methodology, investigation formal analysis, data curation, writing-original draft & writing-review. Neama Kamel: Conceptualization, methodology, investigation, writing-original draft, writing-review & editing. Eman Sameh Abd Elhay: Methodology, preparation and collecting data of the study, investigation, and data statistical analysis. Nora Ghalib AlOtaibi: Conceptualization, methodology, investigation, writing-original draft, writing-review & editing. Ayman Mohamed El-Ashry: Conceptualization, preparation and collecting data of the study, methodology, investigation & editing. Nagla Saleh AlSaleh: Conceptualization, preparation and collecting data of the study, methodology, investigation & editing. All authors approved the submitted and revised versions and agreed to be accountable for the final version.

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AlOtaibi, N.G., Alshowkan, A., Kamel, N. et al. Assessing perceptions about critical thinking, motivation learning strategies in online psychiatric and mental health nursing education among Egyptian and Saudi undergraduate nursing students. BMC Nurs 22 , 112 (2023). https://doi.org/10.1186/s12912-023-01264-2

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DOI : https://doi.org/10.1186/s12912-023-01264-2

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• Mental health nursing

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Graduate nurse aims to close the gap between physical and mental healthcare

Madeline bleier is trading critical care nursing to address a critical need in nursing.

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Madeline Bleier can’t pinpoint exactly when or how she decided to become a nurse, but she knew she loved working with people and had a passion for science. Bleier, the only nurse in her family, chose the profession simply because she thought she would enjoy it.

She never looked back, obtaining a bachelor’s degree in nursing from Case Western Reserve University in Cleveland while working as a critical care nursing tech.

After graduating in 2014, Bleier worked as a registered nurse (RN) in a medical intensive care unit (ICU) at a trauma center in Cleveland, where she found she had a passion for critical care nursing. With one or two patients at a time, Bleier could develop strong relationships with the patients and their families.

“The healthcare system has always separated physical health and mental health, but the truth is, our physical health needs and psychological health needs are going on at the same time,” Bleier said.

“Mental healthcare shouldn’t be looked at differently than going to your regular doctor,” she added. “It should be treated the same as any other healthcare issue, but for most people, it’s easier to share their physical healthcare concerns than mental healthcare concerns. I wish it weren’t that way. I would like to bring those closer together for people.”

The healthcare gap

Despite having performed CPR in the hospital many times, Bleier felt like she saved someone for the first time when she took a break from the ICU to work as a nurse in a rural health clinic providing HIV and Hepatitis C care. There, she administered long-acting antipsychotic drugs to patients, working with psychiatric mental health nurse practitioners to titrate doses and monitor symptoms. She observed that with improved mental health stability, patients engaged more in their primary care and were better able to keep their HIV stable.

“This experience confirmed what I had already known from working with patients in the ICU: mental health is the cornerstone of healthcare,” she said.

Bleier returned to critical care nursing during the COVID-19 pandemic and again saw the mental health theme, but this time, among her colleagues. As a result, she transitioned to a nurse educator role in the ICU, supporting patients and the nursing staff.

However, a firsthand experience with the mental healthcare system after losing her brother to gun violence in 2016 solidified Bleier’s desire to return to school for a degree in psychiatric mental health nursing.

“I was surprised at the difficulty in receiving mental health support from the justice system,” Bleier said. “My family was fortunate enough to be able to seek mental healthcare on our own, but I frequently think of victims of trauma who do not have easy access to mental healthcare. ‘What happens to them? How do they survive?’”

A new kind of nursing

Bleier entered the Family Psychiatric Mental Health Nurse Practitioner (FPMHNP) program at Binghamton University’s Decker College of Nursing and Health Sciences in August 2022.

“I liked that I could connect to rural and urban communities at Decker,” Bleier said. “And it has a fantastic reputation!”

Glodstein also graduated from Case Western Reserve University and joined Binghamton around the same time Bleier began her studies, which helped the two form a close bond.

“Dr. Glodstein is a big supporter of my critical care background and has strived to understand where I’m coming from. Her clinical experience and expertise have influenced me,” Bleier said. “But she’s not only supportive of me in a warm, empathetic way, she also pushed me to improve my writing in a way that I didn’t think I was capable of.”

“Maddie is a dedicated learner who takes her work seriously and strives to increase her knowledge,” Glodstein said. “Her experiences working as an acute ICU nurse, assisting infectious disease patients and colleagues during the COVID-19 pandemic, led her to investigate mental health concerns for both patients and nurses.”

Glodstein added that Bleier is a deeply compassionate individual. Despite the many challenges faced by those in the nursing profession, she continues to expand her knowledge and skills to better serve her patients.

Looking ahead

Following graduation and successfully gaining certification to become a psychiatric mental health nurse practitioner, Bleier hopes to find a role where she can combine her passion for medical and mental healthcare. She can also see herself returning to the classroom for a doctorate in nursing at some point to share her clinical expertise with nursing students.

“It’s the impact I’ll have had on my patients that’s important to me when I look back on my career someday,” Bleier said.

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