Emotional Distress and Attitudinal Changes in Nursing Students During the Psychiatric Practicum: Impact of Patient Aggression.

purposeThis study aimed to examine changes in nursing students' emotional distress and attitudes toward mental illness during their psychiatric nursing practicum, paying particular attention to the influence of students' personality traits, patients' aggressive behaviour and diagnoses on such changes.

methodsNinety nursing students completed self-reported questionnaires before and after their psychiatric practicum. This prospective study examined changes in emotional distress, assessed using the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory II (BDI-II), and changes in attitudes toward psychiatric patients assessed using the Attitudes to Mental Illness (AMI) scale. The study also explored associations between students' personality traits measured using the Tridimensional Personality Questionnaire (TPQ), patients' diagnoses and the students' exposure to patient violence or self-harm events during the practicum.

resultsPost-practicum BAI and BDI-II scores decreased significantly (by 2.62 and 2.90 points, respectively), and AMI scores improved by 2.47 points. Higher pre-practicum anxiety and depression were associated with harm-avoidance traits. Although exposure to violence or self-harm did not significantly affect emotional distress scores, students who did not witness patients' aggressive behaviour showed greater improvement in reducing negative stereotypes (3.32 vs. 1.14, t = 3.638, p < 0.001).

conclusionThe psychiatric nursing practicum significantly reduced nursing students' emotional distress and improved their attitudes toward mental illness. However, exposure to patient violence or self-harm events during the practicum limited gains in positive attitudes toward psychiatric patients. The association between harm-avoidance personality traits and emotional distress suggests that students with these traits may benefit from targeted educational support. RELEVANCE TO MENTAL HEALTH NURSING: This study deepens understanding of how psychiatric practicum experiences shape nursing students' emotional responses and professional attitudes. It highlights the need for educational environments that actively support students when facing challenging clinical situations, particularly patient aggression. The findings underscore the value of supervision, reflection and structured learning processes in preparing nursing students for compassionate, resilient and recovery-oriented mental health practice.