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Mental Health Simulations: The Use of High-fidelity Simulation in Psychiatric and Mental Health Nursing Clinical Education

Mental Health Simulations: The Use of High-fidelity Simulation in Psychiatric and Mental Health Nursing Clinical Education
International Journal of Health Sciences Education
Volume 2, Issue 1, June 2014
© 2014 Academic Health Sciences Center East Tennessee State University

Bethany A. Murray
Indiana University – Columbus


Background: High-fidelity simulation recreates real-life situations in a safe learning environment and encourages critical thinking in students. Published research in simulation in psychiatric/mental health nursing is sparse.

Methods: Four scenarios exemplifying drug or alcohol abuse utilizing the computerized, mannequin SimMan® were implemented. Students evaluated their learning experience following completion of the simulation via a 20-item, Likert-scale survey which included open-ended questions.

Results: Results were positive. Students rated all items on the survey as “agree” or “strongly agree” (Mean 4.77, SD=0.55).

Conclusions: High fidelity clinical education simulations are an effective means of facilitating student learning of psychiatric and mental health clinical experiences. Students found simulation to be a useful and engaging means by which to learn to care for clients with drug or alcohol abuse disorders.

Please find key points from the article below or view the article in its entirety here.

  • Typically, psychiatric and mental health (PMH) nursing, including the treatment of drug or alcohol addiction and dependency, is taught through traditional lecture plus concurrent hospital or community-based clinical experiences. Clients with PMH or behavioral disorders are regularly encountered in medical-surgical hospital settings but student nurses often lack the opportunity to care for this high-risk population during traditional clinical experiences (Brown, 2008; Kameg, Howard, Clochesy, Mitchell, & Suresky, 2010; Nehring & Lashley, 2009; Norman, 2001). Occasionally, trained actors who function as standardized patients are used to role-play a simulated client care situation and psychiatric and mental health nursing faculty have used standardized patients in place of “real” patients to help students learn assessment communication skills (Alexander & Dearsley, 2013; Guise et al, 2012; McNaughton, Ravitz, Wadell & Hodges, 2008). Less often, HFCE is used to teach PMH concepts and skills (McNaughton, et al, 2008). In general simulation has been used for teaching physical skills and competencies but there are few standardized patient care scenarios for use in psychiatric nursing (Brown, 2008).
  • Simulation can be used by faculty to connect course objectives and clinical competencies to learning outcomes, and to improve interpersonal, psychomotor, technical and interdisciplinary team work skills. Simulation:
    • Allows students to practice psychomotor skills and decision-making in a safe and realistic environment;
    • Permits instructors to provide structure and consistency in client care encounters;
    • Promotes teamwork;
    • Provides opportunities to practice low frequency, difficult or high risk tasks eliminating risk to real clients;
    • Increases confidence in providing care;
    • Can accommodate different learning styles; and,
    • Can increase self-efficacy in the student through experiential and affective learning
    (Brown, 2008; Kaakinen & Aarwood, 2009; Nehring & Lashley, 2009; Schoening, Sittner, & Todd, 2006).
  • The items that the students had the most agreement on were as follows:
    • The students viewed simulation as a valuable learning experiences;
    • The students believed simulation should be included routinely in the curriculum; and,
    • The knowledge gained from the simulation could be transferred to the clinical setting.
  • Use of high-fidelity simulation can help to address all of these problems: a) Students can practice caring for clients with high risk or infrequently encountered psychiatric or behavioral problems; b) simulation scenarios can be observed, stopped and guidance given to students; and c) anxiety can be reduced by encouraging a supportive, formative learning environment.
  • Simulated situations can activate the same learning processes as do traditional clinical education. Students are exposed to clinical situations and they must draw on their knowledge in order to make meaning of what they are seeing, formulate ideas and opinions based on their observations, make decisions (plans) as to their actions, reflect on these decisions, and then carry out actions. HFCE scenarios can act as triggers for the development of those skills and allow students to practice the process of nursing care in a methodical and structured setting.
  • Results and Feedback from the Simulation Experience
    Positive Comments
    • Simulation activities are an excellent/effective teaching tool
    • I would like to do more!
    • Excellent! Very well put together. I learned a lot from it!
    • The experience went well. I liked that I was able to be in the family member role. That gave me a
    different perspective on nursing care.
    • I think it was a good way for us to assess whether we can apply what we learned.
    • Good experience.
    • We need to do this more often!
    • The simulations were helpful in activating critical thinking & decision-making skills.
    • It helped me be/see situations I haven’t yet been exposed to in the actual clinical setting.
    Other Comments
    • Need Pixus® (medication) machine in client room/med room.
    • I prefer real clients.
    • Need more simulation dates.
    • I think everyone should participate as a nurse.
    • Simulations usually make me nervous because I’m in a new environment and I don’t know where
    everything is in it.
  • Conclusion: Simulation is an effective means of augmenting real-life clinical experiences for undergraduate nursing students. Simulation scenarios are complex, intentional teaching tools which require an understanding of experiential, constructivist, and reflective learning theories to maximize student learning. High-fidelity clinical experience simulations are especially useful for helping students to practice and learn nursing care with infrequently encountered or high risk situations. Nurses in the medical-surgical and emergency room settings commonly encounter patients experiencing psychiatric and mental health problems. HFCE provides a means to practice caring for these patients prior to these encounters. In this study, HFCEs were utilized to help students develop critical decision making and communication skills in working with clients experiencing drug or alcohol abuse disorders in the acute care setting. Student feedback was overwhelmingly positive and indicated that this was a valuable and worthwhile learning activity. Simulation should not be thought of as a poor replacement for missing or inadequate clinical experiences; rather, simulation itself is an extremely important resource tool that should be incorporated into all psychiatric and mental health nursing clinical education practices.

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