Worlds apart in the same town? A qualitative comparison of pre- and post-clinical themes assessing student nurse perceptions of homeless, mentally ill clients.

Student nurses' negative attitudes towards men who are homeless and mentally ill disrupt development of therapeutic relationships. Without therapeutic relationships these men may feel stigmatized. Assessing student attitudes allows for insights to improve students' abilities to develop therapeutic relationships. The purpose of this research was to assess student nurses' pre- and post-perceptions towards homeless mentally ill clients during a mental health clinical through analysis of pictorial data. Data was analyzed through a qualitative, phenomenological method. On the first and last days of clinical experience, students were asked to draw a picture in response to the question: "How far apart are you from these men?" We analyzed pre- and post-drawings separately and changes were compared. Four pre-attitude themes and two post-attitude themes were identified. Pre-attitude themes demonstrated student drawings as geographically distanced from the clients and living in two different worlds. Post-drawings reflected themes where clients and students were under the same roof and often physically touching. We suggest using this easily reproducible, inexpensive method to gain insights into student attitudes. The difference in the drawings objectively demonstrates the effectiveness of clinical experiences in changing student nurse attitudes towards men who are homeless and mentally ill.