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The context for this work is complex – all students are faced with academic stressors, which can be further compounded by factors including separation from their support networks and post-graduation job insecurity. Learners paying for their education have increased financial worries and high expectations of their academic achievement. Widening participation has rightly allowed access to many non-traditional students, but it has also led to an increase in people with additional learning needs, many of whom are underserved (Royal College of Psychiatrists, 2011). The number of students experiencing mental health problems has increased significantly and levels of suicide in university settings continue to rise (Thorley, 2017).

Students studying to become nurses have added expectations in that they must also develop professional behaviours and navigate emotionally demanding workplaces. Nurses must be self-aware and able to think critically in order to understand information, prioritise actions and exercise professional judgement. They also need to demonstrate compassion and cultural competence and they must also be resilient. Unusually for an academic course, the character, values and behaviours of learners form an important part of their assessment. This means that learning takes places across a range of dimensions from understanding theory to undertaking practical skills, on into ethical, philosophical and critical thinking and developing a professional identity – both in person and as digital citizens.

‘Students studying to become nurses have added expectations in that they must also develop professional behaviours and navigate emotionally demanding workplaces.’

The students studying in partnership with us form an unusual demographic. The student nurses engaging with our programmes are mostly local – Londoners form 73.8 per cent of our cohort. Two-thirds (66 per cent) are from black and minority ethnic groups and most attended state schools or colleges (98.3 per cent). Nearly half are mature students (48 per cent) which means they are more likely to have carers’ duties. They have comparatively low/non-tariff entry qualifications and when they qualify, most will go on to work locally as urgently needed adult, child or mental health nurses.

Expansive Learning

This is a new module designed to meet the needs of these learners with input from stakeholders including service users, clinicians, staff and students. We deliver our content through three face-to-face sessions and via self-directed online learning (see figure 1) which allows students to support each other while being flexible.

Figure 1: An excerpt from the @MDX_EL Twitter feed demonstrating independent and peer-assisted learning around digital professionalism and study skillsThe module also includes input from museums and galleries (British Museum, Victoria and Albert, and the National Gallery) and colleagues with a range of creative backgrounds. This is a deliberate strategy to draw on art and culture as resources to support student nurses to develop resilience and professional sense of self in order to participate in a profession recognised as challenging (McKie, 2012).

Art is not a panacea, but appreciating creativity can be nurturing on a personal level and provides opportunities for student nurses to develop applied skills through active enquiry and reflection (Frei, Alvarez, & Alexander, 2010). Being able to work positively with diversity is a necessary skill in society, and art and culture are used to support student nurses to explore the human condition outside of the biomedical model and develop the knowledge and skills which enable them to flourish as active citizens (see figure 2). (Moorman, Hensel, Decker, & Busby, 2017).

Figure 2: Learning outside the classroom, there are also options for this activity to include students who are commuters or carers

Another way students are supported is by encouragement to recognise and regulate their emotions, one way we do this is by working with animals (Crossman & Kazdin, 2015). Our canine teaching assistants can have positive roles to play in supporting students to achieve their academic goals while also encouraging physical and psychological wellbeing (see figure 3).

Figure 3: A student with a canine teaching assistant

We drew on research that shows improvements in student retention, wellbeing and academic achievement to ensure evidence-based practice and offer a range of flexible drop-in opportunities for students (Binfet & Passmore, 2016). We also have hypoallergenic options in the form of reptile contact!

The authors work collaboratively on a number of projects, most recently on the design and delivery of a module delivered to all fields of nursing called Expansive Learning which informed many of the ideas discussed in this article.


Binfet, J. T., & Passmore, H. A. (2016). Hounds and homesickness: The effects of an animal-assisted therapeutic intervention for first-year university students. Anthrozoös, 29(3), 441–454.

Crossman, M. K., & Kazdin, A. E. (2015). Animal visitation programs in colleges and universities: An efficient model for reducing student stress. In H. A. Fine (Ed.), Handbook on animal-assisted therapy (pp. 333–337). San Diego, CA: Academic Press.

Frei, J., Alvarez, S. E., & Alexander, M. B. (2010). Ways of seeing: Using the visual arts in nursing education. Journal of Nursing Education, 49(12), 672–676.

McKie, A. (2012). Using the arts and humanities to promote a liberal nursing education: Strengths and weaknesses. Nurse Education Today, 32(7), 803–810.

Moorman, M., Hensel, D., Decker, K. A., & Busby, K. (2017). Learning outcomes with visual thinking strategies in nursing education. Nurse Education Today, 51, 127–129.

Royal College of Psychiatrists. (2011). Mental health of students in higher education (College report CR166). London.

Thorley, C. (2017). Not by degrees: Improving student mental health in the UK’s universities. London: Institute for Public Policy Research.