Nursing studies

Adult nursing degree that embraces the blurred boundaries of physical and mental health

University of Exeter’s new programme represents a significant shift in nurse education – and many will say, not before time

University of Exeter’s new programme represents a significant shift in nurse education – and many will say, not before time

Picture: Alamy

Mental health issues present in every clinical environment, yet most students on adult nursing courses only spend a small amount of time learning about mental health in the classroom and on a relevant clinical placement.

When the University of Exeter established its first-ever adult nursing programme in September, we decided to give physical and mental health equal priority.

We rejected the concept of specific mental health modules, instead integrating mental health into our adult curriculum as one of the programme's six ‘pillars’. All the pillars work together, each with a lecturer who acts as a ‘guardian’.

The six pillars of our adult nursing degree programme

  • No health without mental health
  • Fundamental nursing care
  • Evidence for practice
  • Patient and public involvement
  • Global health
  • Leadership and management

Physical and mental health problems often occur together

People with cardiovascular diseases are up to three times more likely to have depression than the general population, and we see many patients in clinical practice who wonder whether poorly managed diabetes causes their depression, or vice versa.

Shockingly, people with serious and enduring mental health problems are up to four times more likely to die prematurely than the population average.

With many public figures, including celebrities, members of the royal family and politicians, talking about their mental health, awareness has increased. But we still have a long way to go.

Educating nurses to understand the whole reality of the individual

Take loneliness, which is associated with rates of death comparable to those caused by smoking and excessive alcohol intake. Lonely people have a higher mortality risk than those who are obese, so why do nurses not give loneliness the same clinical attention as they afford to smoking, drinking and weight issues?

It makes no sense to us that nursing students should be educated as if physical and mental health were separate. This concept harks back to Ancient Greek philosophers, and it is time to move on.

Change is needed, and what better place to start than day one of a nursing degree. Our vision is that nursing students at Exeter, and hopefully elsewhere, will learn to nurse people as they really are – a complex web of physical symptoms, emotions, beliefs and values.

Exeter's first adult nursing cohort is blazing a trail for holistic nurse education

Integrating discussion of mental health into adult nursing practice

Our mental health pillar is informed by evidence-based, cognitive behavioural techniques that are widely available as self-help materials. If people can use these to help themselves, why shouldn’t nurses know how to use them too?

‘Students learn how to turn sympathy into empathy, a crucial skill for nurses’

Students learn about the full range of mental health difficulties: how they present, how common they are and what causes them. Importantly, we help students normalise conversations about mental health in their physical health nursing practice.

The art and science of active listening

Students will develop a deep understanding of the impact of mental health difficulties, learn how to give advice when it is needed, and be able to identify and refer people to services.

They also learn how to turn sympathy into empathy, a crucial skill for nurses. In psychological therapies, we talk about ‘common factors’ – communication skills such as empathy, question-funnelling, reflection and summarising.

These skills are transferrable to the adult nursing field. Our students learn how to use them so that every patient knows they have been actively listened to.


Our teaching borrows from psychological therapies

We use a mixture of teaching methods with our students, including lectures, seminars, problem-based learning, simulations, role play and real clinical immersion.

All our adult nursing students learn the same techniques as NHS psychological well-being practitioners, and have a placement focusing an improving access to psychological therapies (IAPT) services in their first year.

Staff and students are supported by the pillar guardian to include mental health issues in their physical health teaching and learning.

For example, our session in which students learn about obesity and body mass index (BMI) is followed by another shortly afterwards, in which they role-play how to communicate BMI sensitively, and learn how to help the individual undertake any necessary behavioural changes.

Parity of esteem for mental health proficiencies

Our students also explore complexity in problem-based learning sessions. They learn how to integrate mental and physical health into casework and actively practise integrating physical and mental health.

We expect our adult nursing students to be just as competent in using mental health proficiencies as physical health skills in their practice. This is a significant and much-needed change for UK nurse education.

Lauren Antinoro is a lecturer practitioner at the University of Exeter Academy of Nursing and 'guardian' for the ‘no health without mental health’ pillar



David Richards is professor of mental health services research and head of nursing at the University of Exeter Academy of Nursing



Further information

Exeter adult nursing programme 

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