Integrated Mental Health Nursing Program: Effects on Stigma, Cognitive Flexibility, and Clinical Readiness

Mental health nursing education plays a critical role in preparing nursing students to provide competent, compassionate, and evidence-based care for individuals with mental health disorders. However, stigma toward mental illness, limited cognitive flexibility, and inadequate clinical readiness remain important challenges among undergraduate nursing students. These challenges may negatively influence students' attitudes toward mental health care, reduce confidence in psychiatric settings, and affect the quality of care delivered to patients with mental illness.

This study is designed to examine the effect of an Integrated Mental Health Nursing Educational Program (IMHNEP) on three key outcomes among nursing students: stigma, cognitive flexibility, and clinical readiness. The study will use a quasi-experimental one-group pretest-posttest design.

The study will be conducted at the Faculty of Nursing, Damanhour University, Egypt. Participants will include undergraduate nursing students enrolled in the psychiatric nursing course during the second clinical rotation of the 2025-2026 academic year. A convenience sample of 240 students will be recruited. Eligible participants are students enrolled in the psychiatric nursing course who have no prior psychiatric nursing experience or previous clinical exposure to psychiatric patients. Students who have previously studied psychiatric nursing or have prior experience caring for psychiatric patients will be excluded.

The intervention, IMHNEP, is a structured educational and clinical training program delivered over 6 consecutive weeks from April to May 2026. The program includes lectures, interactive discussions, reflective learning activities, case-based learning, and supervised clinical training experiences. The educational content focuses on mental health awareness, stigma reduction, cognitive restructuring approaches, and essential psychiatric nursing competencies. The program is intended to improve students' attitudes toward mental illness, promote flexible thinking and adaptive reasoning, and increase confidence and readiness for clinical psychiatric nursing practice.

Data will be collected at two time points: pre-intervention assessment during the first week of the program and post-intervention assessment during the final week of the program. The primary study outcomes will be measured using validated instruments. Stigma will be assessed using the Opening Minds Stigma Scale for Health Care Providers (OMS-HC-15). Cognitive flexibility will be assessed using the Cognitive Flexibility Inventory (CFI). Clinical readiness will be assessed using the Mental Health Nursing Clinical Confidence Scale (MHNCCS).

Participation in the study will be voluntary. Informed consent will be obtained from all participants before data collection. Confidentiality and anonymity will be maintained throughout the study, and participants will have the right to withdraw from the study at any time without penalty.

This study may provide evidence on the effectiveness of an integrated mental health nursing educational intervention in reducing stigma and improving adaptive thinking and clinical preparedness among nursing students. The findings may contribute to improving undergraduate psychiatric nursing education and supporting better preparation of future nurses for mental health care settings.

Inclusion criteria

• Undergraduate nursing students enrolled in the psychiatric nursing course at the Faculty of Nursing, Damanhour University
• Students assigned to the second clinical rotation during the second semester of the 2025-2026 academic year
• Students who have not previously studied psychiatric nursing
• Students with no prior clinical exposure to psychiatric patients
• Students who are willing to participate and provide informed consent

Exclusion criteria

• Students who have previously studied psychiatric nursing
• Students with prior experience caring for psychiatric patients in hospital or clinical settings
• Students who refuse to participate
• Students who do not complete the pre-test or post-test assessments