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Undergraduate nursing students’ experience of mental health simulation post‐clinical placement: A Qualitative study
Abstract
In nursing, it is vital that educational techniques are developed to improve students’ capabilities to communicate with and assess mental health consumers while on placement. Simulation is a valid learning technique used to prepare students to encounter consumers with mental illness before exposure in the clinical environment. The aim of this study was to explore undergraduate nursing students’ experience mental health simulation following their mental health clinical placement. An explorative descriptive qualitative study. Participants were recruited from a metropolitan Melbourne university using purposive convenience sampling. The participants were interviewed after their mental health clinical placement using semi‐structured interview format. A total of n = 14 participants were interviewed. Overall, the participants expressed the fact that the mental health simulation enhanced their clinical placement experience. Two themes were identified: ‘The things I might see’ and ‘Felt better prepared’. There was a total of five subthemes: ‘The link between…’, ‘Having the know how’, ‘Like an 8‐hour shift’, ‘Took away the fear factor’ and ‘Feeling more confident’. It is important that nursing students entering mental health settings receive adequate preparation prior to the commencement of their placements. Students need to be prepared in the areas of building therapeutic relationships, communication, assessment and how to work within a mental health clinical setting. The mental health simulation enhanced students’ confidence and better prepared them to undertake their clinical placement which can ultimately affect the care provided to consumers.
... Simulation in health care education is the reproduction of a clinical environment for the purpose of teaching, examin-The importance of interpersonal skills for all nurses, particularly those in mental health settings, cannot be overstated. Mental health nursing requires a unique set of skills that include interpersonal skills as the foundation of mental health care, as well as clinical skills in de-escalation and negotiation, critical thinking, and assessment skills including mental state and risk assessment ( Goh et al., 2021 ). Interpersonal skills for mental health are nuanced and include fundamental communication skills including openended questioning, clarifying, paraphrasing, and validating ( Blake & Blake, 2019 ), and more advanced interpersonal skills including reflective practice, boundary maintenance and reflexivity ( Schwind, McCay, Metersky, & Martin, 2016 ). ...
... In a curriculum that does not utilise mental health simulation, a student's first attempt to engage therapeutically with a person with mental illness may be during their clinical placement. Research has identified that students feel anxious about engaging with people with mental illness ( Goh et al., 2021 ). Yet higher student clinical confidence in mental health nursing has been correlated with increased preparedness for placement, and reduced anxiety about en-gaging with people who have mental illness ( Lim et al., 2020 ). ...
... The degree to which simulation provides a realistic portrayal of a clinical situation is defined as realism ( Lioce et al., 2020 ). Twelve studies reported on how realism was important to students' learning experience in mental health ( Alexander, Sheen, Rinehart, Hay, & Boyd, 2018 ;Donovan & Mullen, 2019 ;Felton, Holliday, Ritchie, Langmack, & Conquer, 2013 ;Garcia-Mayor et al., 2021 ;Garvey, Willetts, Sadoughi, & Olasoji, 2021 ;Knutson de Presno, Ogard-Repal, & Fossum, 2021 ;Olasoji, Huynh, Edward, Willetts, & Garvey, 2020 ;Soccio, 2017 ;Stockmann & Diaz 2017 ;Thompson Martin & Chanda 2016 ;Verkuyl et al., 2017Verkuyl et al., , 2018. Perceived realism was reported in qualitative (n = 6), quantitative (n = 4), and mixed methods studies (n = 2) that included simulated participants (using same script and scenario) (n = 9), mannikins (n = 1), and virtual (n = 2) simulation modalities. ...
... Previous studies have explored nursing students' perceptions and experiences of the use of simulation in mental health settings (Garvey, Willetts, Sadoughi, & Olasoji, 2021;Øgård-Repål et al., 2018). The results suggest that debriefing motivates students through feedback from peers and instructors, improving their communication skills, cognitive learning (Sarikoc, Ozcan, & Elcin, 2017), empathy and, sensitivity towards patients with mental disorders (Doolen et al., 2014;Garvey et al., 2021). ...
... Previous studies have explored nursing students' perceptions and experiences of the use of simulation in mental health settings (Garvey, Willetts, Sadoughi, & Olasoji, 2021;Øgård-Repål et al., 2018). The results suggest that debriefing motivates students through feedback from peers and instructors, improving their communication skills, cognitive learning (Sarikoc, Ozcan, & Elcin, 2017), empathy and, sensitivity towards patients with mental disorders (Doolen et al., 2014;Garvey et al., 2021). ...
... Through "Preparation," along with the experience of being "Welcomed and wanted" students can feel included and arrive ready to learn. This echoes other studies that highlighted the importance of preplacement student preparation (e.g., in nursing skills and communication techniques) (McLeod et al., 2021;O'Brien et al., 2019) along with effective communications between university, placement facilities, educators and students, to facilitate a positive placement experience for students (Garvey et al., 2021;O'Brien et al., 2019). From a placement organization perspective, elements such as orientation, appointing preceptors and structuring the placement were conducive to learning (Birks et al., 2017), whereas disinterested and unwelcoming staff were a hindrance (Cooper et al., 2015). ...
... Time and support for students to practice and use the strategies in preparation for, and during clinical placement is also needed. For example, a university workshop was valued by students as preplacement preparation (Garvey et al., 2021). ...
Introduction
Clinical placements are a mandatory component of nursing students’ education internationally. Despite clinical education being a key to nursing students’ achievement of nursing competencies, few studies have reviewed students’ narratives to describe their experiences of learning during clinical placement. Such studies may be important in offering a deeper insight into clinical learning experiences than quantitative surveys.
Methods
A systematic thematic synthesis of qualitative studies between 2010 and June 2020 was conducted. English language studies that offered a thematic analysis of undergraduate nursing students’ experiences of learning during placement were sought. A search was made of five databases PubMed, Ovid Medline, CinahlPlus, SCOPUS, and Google Scholar. The study was guided by the ENTREQ statement for enhancing transparency in reporting the synthesis of qualitative research.
Results
Twenty-seven qualitative studies were included in the review. A thematic synthesis showed over 100 themes and subthemes across the studies. A cluster analysis revealed positive elements and others that were seen in the studies as a barrier (hindrance) to clinical learning. Positive elements included supportive instructors, close supervision, and belonging (in the team). Unsupportive instructors, a lack of supervision and not being included were seen as a hindrance. Three key overarching themes that could describe a successful placement were revealed as “Preparation,” “Welcomed and wanted” and “Supervision experiences”. A conceptual model of clinical placement elements conducive to nursing students’ learning was developed to enhance understanding of the complexities associated with supervision. The findings and model are presented and discussed.
Conclusion
The conceptual model presents positive elements that influence students’ clinical placement experiences of learning. This model may provide a framework to guide professional development programs and strategies to support students and supervisors alike, an important step forward in moving beyond the current clinical placement rhetoric.
... learning outcomes by increasing satisfaction and confidence ( Brown, 2015 ;Goh, Selvarajan, Chng, Tan, & Yobas, 2016, Garvey et al., 2020. Simulations with SPs are also used to enhance interprofessional collaboration by highlighting differences in nursing and psychology students' approaches to handling patients ( Munoz-Rubilar et al., 2020 ). ...
... This result supports the results of studies concluding that students who participated in simulations in mental health nursing experienced significantly increased confidence, knowledge, and ability in mental health care ( Kunst, Mitchell, & Johnston, 2017, Garvey et al., 2020. This learning process might indicate there is some reinforcement of the students' belief in coping with similar nurse-patient meetings in their upcoming clinical placements. ...
Background
Nursing students often express uncertainty about clinical placement in a mental health care setting. Simulation with standardized patients may provide an opportunity for students to explore clinical situations in mental health nursing before their clinical placement, thereby increasing these students’ overall satisfaction and confidence levels with regard to mental health nursing.
Method
A qualitative descriptive design was selected. Twenty-four undergraduate nursing students participated in four focus-group interviews after mental health simulations with standardized patients were conducted. Thematic analysis was used to analyze the data.
Results
Three main themes were identified: (1) preview into everyday life in a psychiatric ward, (2) adjusting assumptions and apprehensions regarding mental health nursing and, (3) mutual respect during the nurse-patient meeting.
Conclusions
The simulations were valuable in preparing students for mental health clinical placements by increasing their belief in capability to act appropriately in clinical scenarios.
... Several studies found that simulated patient-based training endows students with high levels of self-confidence by improving their clinical competencies and communication skills in psychiatric settings and enhancing their abilities to carry out clinical tasks and abilities to work in teams. Moreover, the participating students felt confident and prepared for real-world encounters with mental health patients [21,24,[26][27][28][29][30]. Meanwhile, Johnson et al. [25] reported that using standardized patient simulation for first-semester nursing students was not effective in improving their self-confidence. ...
Background: The use of standardized patient simulation in psychiatric nursing education addresses the unique challenges presented by mental healthcare settings. Students’ attitudes toward clinical simulation remain predominantly favorable, with many expressing enthusiasm for the opportunities it provides in terms of embracing challenges, enhancing realism, and promoting critical thinking through problem solving, decision-making, and adaptability. Methods: This quantitative study used a cross-sectional, descriptive, correlation design to investigate the effectiveness of standardized patient simulation as a teaching method in the Psychiatric and Mental Health nursing course in a university setting. A total of 84 nursing students were recruited for the convenience sample. Data were collected using a three-part questionnaire survey which included the following: a demographic data sheet, the Student Satisfaction and Self-confidence in Learning Scale, and a narrative open-ended question asking the participants to write the advantages and disadvantages of their simulation experience. Data were analyzed using the statistical software JMP pro17. Results: The total satisfaction with learning subscale score ranged between 5 and 25 with a mean score of 19.36 ± 6.32. The total self-confidence subscale score ranged between 8 and 40 with a mean score of 30.87 ± 9.1. Pearson’s correlation coefficient r revealed a statistically significant positive relationship between the participants’ satisfaction with the learning experience and their self-confidence (t = 0.923, p < 0.0001). Approximately 91.7% of the students recommended using simulation. The results confirmed the students’ recommendations of simulation use in teaching psychiatric and mental health courses; furthermore, the results showed a statistically significant positive correlation with the total SSLS (p = 0.01) and satisfaction with learning subscale (0.003). Participants reported that authentic, practical, comfortable, and safe learning environments contributed to an enriched learning experience. Additionally, factors such as timesaving, access to information, cost-effectiveness, standardized teaching, varied exposure, skill development, and immediate feedback also enhanced the learning experience through patient simulation in psychiatric and mental health nursing. Conclusion: Simulations can contribute efficiently and positively to psychiatric and mental health nursing education in a manner that optimizes the learning experience while ensuring the consistency of student learning in a safe learning environment.
... In one of the studies where a low fidelity simulator was designed to communicate with patients suffering from mental disorders, it was observed that in addition to communication skills, students were able to learn decision-making skills and therapeutic interventions, and their reflection and critical thinking also improved [36]. In another qualitative study, it was also shown that mental health simulation has improved the experience of a placement in the clinical environment [37]. Since the use of new technologies is favored by young people, it seems that educational instructors should use new educational techniques in teaching and preparing students to attend the mental clinical environment. ...
Background
Since clinical experience is challenging, identifying the factors influencing the learning process and acquiring clinical competence in mental departments is essential. Limited studies have investigated students’ concerns regarding attending this clinical setting and how they are mentally and academically prepared.
Aim/question
Explaining the various aspects of nursing students' preparation to attend the mental clinical environment.
Methods
This qualitative study was conducted on bachelorette nursing students and college professors using in-depth, semi-structured interviews. Inductive content analysis was used for data analysis, and Lincoln and Guba’s criteria were used for the rigor of the data.
Results
The participants’ viewpoints regarding how to prepare nursing students to enter mental clinical settings can be summarized in 4 categories: “understanding the students’ concerns” “understanding the students’ expectations” “the necessity of the students’ mental preparation” and “preparing the scientific materials needed to attend in a mental ward”.
Conclusion
Nursing students have fears and worries about entering mental departments and have expectations of themselves and their instructors. To help students deal with these concerns, psychological and educational preparations should be provided, among which the role of new educational technologies can be mentioned.
... A multitude of simulation types, including virtual simulation and in-person simulation using a standardized patient, have been shown to enhance student learning through the development of knowledge, skills, and confidence (Vandyk et al., 2018). Additionally, Garvey et al. (2021) state that engagement in simulation activities before attending clinicals may be beneficial to adapting nursing students academically and mentally for the psychiatric clinical experience. According to the authors, potential benefits may include alleviating feelings of insecurity and uncertainty, as well as preparing students to build rapport with patients, practice therapeutic communication, and conduct assessments. ...
Introduction
The COVID-19 pandemic significantly impacted students in psychiatric clinical rotations. Clinicals were frequently limited or canceled, restricting exposure of student nurses to this experience. Many modifications led to permanent changes in the psychiatric clinical setting.
Objectives
The purpose of this manuscript is to provide a cohesive approach to serving student nurses in the post-pandemic psychiatric clinical setting.
Methods
A theoretical exploration of the literature framed by the Roy Adaptation Model (RAM) was conducted.
Discussion
Results are presented using the four modes of the theory: Physiological, Self-Concept, Role Function, and Interdependence.
Conclusions
Findings include strategies to enhance student learning while supporting students’ health and wellness. Educators and practitioners should provide high-quality, safe learning environments for student nurses.
... Nurses' attitudes toward persons experiencing mental health conditions can have an impact on the quality of the nursing care they deliver. Students who hold negative beliefs and stigmatizing views toward patients with mental health conditions may struggle to build an effective relationship with their patients and may also be reluctant to choose mental health nursing as a career choice ( Garvey, Willetts, Sadoughi, & Olasoji, 2020 ;Kameg, Fradkin, & Lee, 2021 ). Fear of violence and unpredictability attached to mental health conditions cause students to experience anxiety and stress when building rapport with their patients ( Ok et al., 2020 ;Thongpriwan et al., 2015 ). ...
... Standardised patients involve human role players interacting in real time with students [12,20], providing a more realistic learning opportunity [21,22]. Recent studies have demonstrated that simulations with standardised patients enhanced students learning outcomes by increasing satisfaction, self-awareness, and knowledge [23,24]. However, standardised patients are used inconsistently in schools of nursing [25]. ...
Rationale:
Undergraduate nursing students' learning opportunities to practice caring behaviours to assure compassionate and competent nursing practice with standardised patients are few. Earlier studies primarily focused on practicing communication skills in relation to mental health or developing psychomotor skills while caring for a patient with a specific diagnosis.
Aim:
The study aim was to describe undergraduate nursing students' experiences of practicing caring behaviours with a standardised patient.
Method:
A sample of forty-eight undergraduate nursing students in semester four at a school of nursing in southern Sweden, enrolled in a full-time, 5-week, on-campus elective caring behaviour course, were at the first and last week individually video-recorded during two caring behaviour simulations encountering a standardised patient. After observing each of their video-recordings, students completed written reflections focusing on their own compassionate and competent verbal and nonverbal caring behaviour. In total, 96 individual written reflections were analysed using qualitative content analysis to describe the experience.
Results:
One main theme emerged: The challenge of being mindfully present in patient encounters. Four themes further described the experience: A challenging but realistic learning experience, learning the impact of nonverbal behaviour, recognising the complexity of verbal behaviour, and learning to be with the patient instead of only doing for the patient.
Conclusion:
When caring is intertwined with visible and realistic nursing practice in simulations using standardised patients it facilitates undergraduate nursing students learning compassionate and competent caring behaviour. The learning experience opened the students' eyes to the impact of practicing caring, recognising that being with is not the same as doing for the patient, and thus, how challenging it is to be mindfully present in patient encounters. Designing caring behaviour simulations with standardised patients is a feasible and efficacious educational learning didactic to facilitate students' learning caring behaviour and enhancing patients' experiences.
Purpose: This study aims to systematically review the literature and conduct a meta-analysis to thoroughly analyze the outcomes of studies on simulation programs in psychiatric nursing.Methods: We conducted an initial search from January 1, 2000, to September 30, 2023, using databases such as PubMed, EMBASE, CINAHL, the Cochrane Library, and Web of Science. A total of 2,571 articles were reviewed based on inclusion and exclusion criteria. We selected 35 articles for systematic literature review and subjected 20 of them to meta-analysis. Data analysis was conducted using descriptive statistics and the Comprehensive Meta-Analysis program.Results: The number of psychiatric nursing simulation programs has increased since 2015. The most common programs used Standard Patients (SP), but studies using Virtual Reality (VR), audio, video, and other methods have recently been reported. The programs addressed various mental health issues, including depression, suicide, violence, alcohol problems, and mood disorders. Overall, considering all the studies, a significant effect was observed with a pooled Hedges’s g value of 0.56 (95% CI: 0.35~0.78; p <.001).Conclusion: These findings highlight the importance of incorporating simulation-based education into nursing curricula to equip professionals with the skills to provide high-quality care to individuals with mental health problems. Further research is needed to explore the long-term benefits of these educational interventions on patient care.
Purpose
Large numbers of nursing students and the COVID-19 pandemic made it necessary to relieve the pressure on UK hospitals to host clinical placements. One hospital innovated by providing a virtual placement online, immediately before an in-person placement. The purpose of this study is to evaluate the participant responses to the online virtual placement.
Design/methodology/approach
This was a pilot study evaluated after the placement, including a student survey (25 responses), four semi-structured interviews with students and four with staff in spring 2021.
Findings
High levels of approval of the innovation were recorded among both students and staff. Students were pleased to be taught by clinical experts, though some found it difficult to study at home and some found the hours long. High satisfaction levels may reflect the pandemic context: the placement reduced social isolation and the sense of education being interrupted. Participating students were in their final year of study, and the placement took place in the second year of the pandemic, so mutual familiarity and well-developed information technology skills may have made the innovation more acceptable.
Practical implications
The innovation has value and should be maintained post-pandemic to increase mental health in-person placement capacity and scaffold student learning.
Originality/value
This study added new knowledge to understanding about the utility of virtual placements in mental health nursing education.
Background
Simulations allow students to be challenged and supported while gaining both technical and non-technical skills within a clinical learning environment. Working in a mental health setting can be quite challenging and confronting at times for undergraduate nursing students in clinical placement. The study aims to explore nursing students’ perceptions of a mental health simulation workshop's impact before clinical placement, which provides a supportive environment to gain technical and non-technical skills while being challenged and supported.
Sample
Participants were a second-year cohort (n = 89) of undergraduate nursing students enrolled in a mental health unit.
Methods
Descriptive survey design. The researchers thematically analysed narrative responses of a pre- and post-simulation survey from an immersive simulation using a descriptive survey design.
Results
The researchers identified six key themes: two from the pre-simulation survey – communication with and assessment of mental health patients, and the opportunity for placement preparation; and four from the post-simulation survey – the opportunity for debriefing, the realism of the simulation, increased confidence levels, and the perception of a safe learning environment.
Conclusion
Effective skill acquisition is essential to advance recruitment and retention into mental health environments. The use of mental health simulation that comprises of realism and immersion working with simulated patients provided opportunity to advance this.
Aim
The aim of this focus group study was to investigate second-year undergraduate nursing students’ experiences with clinical simulation training as part of their clinical practice in acute mental health care.
Background
The quality of bachelor programmes in nursing has been criticised for lacking theoretical and experiential learning in the mental health modules. Novice nurses feel unprepared to care for patients with mental health challenges and graduate nurses are reported to lack the necessary knowledge and skills to manage patients with mental health issues confidently and competently. Clinical simulation training can facilitate the teaching of clinical and non-clinical skills simultaneously and is a highly suitable method within mental health care for addressing gaps in knowledge and skills in communicating with patients. Clinical simulation training may enhance nursing students' competence and thereby reduce the risk of adverse events and increase safety. However, we know little about undergraduate nursing students’ experiences with clinical simulation training as an integrated part of nursing students’ clinical practice in acute mental health wards.
Design
Explorative qualitative focus group study.
Method
Three focus group interviews were conducted using a semi-structured interview guide with second-year undergraduate nursing students from a university in Norway during spring 2020. In total, 14 students who had experienced clinical simulation training as part of their mental health clinical practice participated in the study. The collected data were analysed using systematic text condensation.
Results
Clinical simulation training as part of the clinical practice increased the students’ preparedness, coping and self-awareness. Most of the participants had positive perceptions of the use of high-fidelity simulation-based learning. Furthermore, they highlighted three elements that increased the value of the training. First, the simulation felt authentic and increased their professional skills. Second, the standardised patient had clinical qualifications, which made the simulation feel authentic and close to realistic situations. Third, not having a former relationship with the person acting as the standardised patient enhanced authenticity.
Conclusion
Clinical simulation training as part of clinical practice contributed to increasing the students’ self-awareness and in-depth reflection and to broadening their nursing competence. The present study lays the groundwork for future studies on clinical simulation training in mental health clinical practice for nursing students.
The purpose of the current descriptive qualitative follow-up study was to explore perceptions of post-graduate nurses regarding transferability of student-learned mental health simulation knowledge and skills to actual acute care practice settings. The study used a survey design of eight questions on SurveyMonkey® and there were 11 participants. Questions were specific to knowledge and skills learned as students in three mental health simulation labs and whether they transferred to post-graduate acute care practice settings. Thematic analysis identified the following main themes: Learned Effective De-Escalation Techniques, Felt More Prepared With Psychiatric Assessments, and Feeling Empathy for Patients Hearing Voices. Subthemes were Being Therapeutic With Patients and More Confident in Psychiatric Emergencies. Post-graduate nurses described being able to transfer use of student-learned mental health simulation knowledge and skills to acute care practice settings. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].
Introduction
Female genital cutting/mutilation (FGC/M) is a ritual to remove any or all of the external female genitalia. Educational strategies regarding the teaching of FGC/M for nursing students are scarce. The focus of this article is to describe the development, implementation, and evaluation of a virtual, FGC/M-related dramatization simulation with a standardized patient (SP).
Methods
This educational intervention used an East African immigrant woman as the SP with 35 undergraduate nursing students in two nursing schools in the Midwest United States.
Results
Participants appraised the simulation as an effective way to teach and learn about FGC/M. Debriefing was a key part of the simulation.
Discussion
Students felt the simulation was novel and engaging for a highly sensitive topic. The SP thought the virtual setting made it more comfortable for her to reveal sensitive facts. The researchers confirmed that the simulation required extensive time commitment to develop, critique, and implement.
Background:
Baccalaureate nursing students experience anxiety before working with patients with mental illness who hear voices. A hearing voices simulation and role-play was proposed as an approach to preparing students for clinical practice.
Method:
A qualitative interpretive phenomenological method was used to determine students' perceptions of the simulation experience before their first mental health clinical rotation.
Results:
Through the experience of the Walking in the Shoes of Patients activity, written student surveys revealed themes of Reflecting on Past Experiences, Developing Changed Perspectives, and Different Approaches to Care.
Conclusion:
The hearing voices simulation provided students with a greater understanding of the experience of hearing voices, and the role-play helped students to gain personal insight into patients' behaviors and practice skills learned in preparation for their first mental health clinical experience. [J Nurs Educ. 2016;55(4):203-208.].
Accessible summary:
What is known on the subject? Stress can impact students on mental health nurse training. This can have implications at the individual level (e.g. their own mental health) and at the level of the organization (e.g. sickness absence and attrition). What this paper adds to existing knowledge? We interviewed 12 mental health nursing students regarding the stress they experienced during training. Participants described how the academic demands can at times be unbearable during clinical placements. There were also issues with 'being a student' on some placements, with participants describing negative attitudes towards them from staff. The younger participants reported feeling overwhelmed on their initial placements and described some of the main challenges of mental health work for them. Raising concerns about the quality of care on wards was also described as particularly challenging for the students. What are the implications for practice? This paper can be useful to help training providers support mental health nursing students. Recommendations include reducing academic demands during clinical placements and extending and promoting existing support services beyond normal 9am-5pm working hours, even if these services are limited. Younger students could be better supported by being allocated to the more well-resourced placements in the early stages of their training. Raising awareness among staff of the tasks students can and cannot perform can help improve staff/student relations. Finally, students should be educated about the issues around raising concerns on placements to help the governments drive for a more open and transparent National Health Service (NHS).
Abstract:
Introduction Previous studies investigating stress in nursing students focus on general nursing students or adopt quantitative measures. Purpose of study A qualitative study focusing specifically on mental health nursing students is required. Method One-to-one interviews were carried out with mental health nursing students (n = 12). Data were thematically analysed. Results Participants reported unreasonable demands during clinical blocks, and described how control/support is lowest on placements with staff shortages. Negative attitudes towards students from staff and related issues were also discussed. Younger participants described struggling with mental health work during the early stages of training. Discussion Training providers should strive to provide adequate support to students to help them manage stress during training. Implications for practice Academic demands should be reasonable during clinical blocks and support services outside normal working hours should be available for students, even if these are limited in scope. Greater consideration to the allocation of placements for younger students in the mental health branch could be helpful. Furthermore, staff on placements should be aware of the tasks students can and cannot perform, to help improve staff/student relations. Educating students on the issues of raising concerns can help the governments drive for a more open and transparent National Health Service (NHS).
Background
In the education of professionals in psychiatry, one challenge is to provide clinical placements with opportunities for students to interact and have direct contact with patients. The aim of this study was to explore Swedish psychiatric patients’ perspectives on student participation in their care.
Method
In a cross-sectional survey design, 655 adult psychiatric patients at a university hospital completed questionnaires. These questionnaires included statements about student involvement, student gender, attitudes towards student participation as well as two open-ended questions. Data were analyzed quantitatively and qualitatively.
Results
The majority of the patients were comfortable with student participation. There were no differences between patients in wards compared to outpatients but patients who previously had students involved in their care reported higher comfort levels and a more positive attitude. Female patients were less comfortable with male students and very young students. Patients stressed the importance of being informed about the opportunity to refuse student participation. More detailed information given before the consultation as well as the importance of the student showing a professional attitude was conditions that could enable more patients to endorse student participation.
Conclusion
The psychiatric patients’ overall positive attitudes are in line with previous findings from other specialties and countries. The results support both altruistic motives and experience of personal gains by student involvement. More detailed information given beforehand would enable more patients to consider student participation.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
Learning may be enhanced in mental health nursing education by applying virtual reality technologies in which students may safely practice communication and assessment skills with simulated patients. The purpose of this descriptive study was to assess the effectiveness of a Second Life(®) (SL) virtual simulation as a teaching strategy for undergraduate mental health nursing students. Data were collected via a researcher-developed survey questionnaire. Students perceived the simulation to be moderately effective as an educational strategy and slightly difficult as a technical program. Positive aspects included client assessment in an environment where mistakes were without consequence, working from home, and novelty. Drawbacks were dressing and maneuvering the avatar and lack of realism. Correlations were found between educational effectiveness and technical difficulty and between educational effectiveness and age of the computer. SL virtual simulation has potential to provide unique, easily accessible, safe, and fun learning for mental health nursing students.
PULIDO‐MARTOS M., AUGUSTO‐LANDA J.M. & LOPEZ‐ZAFRA E. (2011) Sources of stress in nursing students: a systematic review of quantitative studies. International Nursing Review 59 , 15–25
Aim: This study aimed to identify the main sources of stress for students of nursing and the evolution of the stressors when training in nursing competences.
Background: Levels of stress are higher for health professionals than for other workers. A higher number of stressors with negative health consequences are present, especially among nursing professionals. Stress is a psychosocial factor that influences the academic performance and well‐being of this group. The interest in analysing sources of stress in nursing students is due to the influence that their training period may have on their perceptions of stress on their future work.
Methods: We conducted a systematic review of the scientific literature on stressors in nursing students. The search comprised all the articles published at the end of 2010.
Results: The most common sources of stress relate to academics (reviews, workload and problems associated with studying, among others). Other sources of stress include clinical sources (such as fear of unknown situations, mistakes with patients or handling of technical equipment). In general, no changes occur at the different years of the student's education.
Conclusion: Comparing studies is difficult because of the differences among them (designs, instruments, number of stressors, etc.). However, our revision gives a current state‐of‐the‐art and includes descriptive information that might be very useful for future research. Furthermore, we offer some recommendations for improving the design of curricula taking into account sources of stress.
Despite completing accredited resuscitation training, neonatal trainees often feel unprepared to deal with real-life clinical emergencies. High-fidelity simulator (HFS) technology offers the potential of recreating a realistic stressful clinical environment to aid training and evaluation. To date, there are limited data examining the physiological impact of this training modality in comparison to less costly alternatives. The objective of this study was to compare the effects of low-fidelity simulator (LFS) versus HFS technology on performance levels, objective and subjective measures of stress in neonatal trainees.
Sixteen neonatal fellows were invited to participate in a prospective randomized study. Subjects were divided into pairs and randomized to LFS or HFS for completion of scenario I. After an interval of 1 month, fellow teams crossed over to complete scenario II using the alternative simulator technology. Technical and non-technical skills were assessed using validated resuscitation scoring tools. Participants recorded subjective stress at sequential time points before and after each simulation. Buccal cortisol was measured at each corresponding time point and comparison between HFS and LFS groups was made.
The mean overall resuscitation performance score was 75.8%±10, but there was no difference in performance between HFS and LFS groups. There was also no significant difference in non-technical skills performance between groups. Salivary cortisol increased over the duration of the simulated experience, but there were no differences between the two groups (P=0.001, two-way repeated measures analysis of variance). We also identified changes in subjective measures of stress (P<0.001, analysis of variance) over time, but again there were no differences between groups.
Simulated neonatal resuscitations induce a significant stress response in neonatal trainees; however, we were unable to identify any difference in stress measures between HFS and LFS. These data suggest that HFS technology offers no additional stress-inducing benefit.
This exploratory study assessed the possible effectiveness of hemiparetic upper extremity training in subjects with chronic stroke with computer instrumentation (haptic force feedback) and 3-dimensional visualization applied to computer games, as well as to evaluate concurrent computer-assisted assessment of the kinematics of movements and test whether any improvement detected in the computer environment was reflected in activities of daily living (ADLs).
A single-subject repeated-measures experimental design (AB) was used. After baseline testing, 5 patients were assigned to the therapy 3 times a week for 45 min for 5 weeks. Velocity, time needed to reach, and hand path ratio (reflecting superfluous movements) were the outcome measures, along with the Assessment of Motor and Process Skills and the Box and Block test. The follow-up phase (C) occurred 12 weeks later.
Improvements were noted in velocity, time, and hand path ratio. One patient showed improvement in occupational performance in ADLs.
The application of this strategy of using virtual reality (VR) technologies may be useful in assessing and training stroke patients. The results of this study must be reproduced in further studies. The VR systems can be placed in homes or other nonclinical settings.
Undertaking a mental health clinical placement can be anxiety‐provoking for nursing students at times. There is a need to adequately prepare undergraduate nursing students for clinical placement in a mental health setting in relation to their skills and confidence. This study aimed to evaluate the effect of a mental health simulation workshop on the skills and confidence of nursing students in providing care to consumers living with a mental illness. The study also evaluated the design of the mental health simulation workshop from an educational perspective. A pre/post‐test survey was administered to a cohort of N = 89 Australian pre‐registration nursing students. Exploratory factor analysis identified three factors: Mental health therapeutic engagement, mental health assessment skills, and mental health placement preparedness. Analyses of pre–post differences indicated that all three factors were significantly different between the initial and follow‐up responses, with follow‐up responses being more favourable. The findings of this study demonstrate that there is value in including mental health simulated patient exercise as part of the learning strategies in the curriculum of pre‐registration nurses. This has implications for the quality of care in the clinical environment and level of preparedness of these students’ nurses for mental health clinical placement where they will be providing care to consumers living with a mental illness under direct supervision.
This paper reports on a unique practice based learning model to prepare undergraduate nursing students for clinical placement. The learning and teaching model described in this paper outlines the establishment of an entire on-campus simulated hospital and health service (SHHS) at the University of South Australia, School of Nursing and Midwifery. The model is pedagogically structured to immerse students in an authentic clinical environment to achieve deep learning in preparation for safe practice. A quality improvement cycle was used to evaluate the outcomes of the model in two phases: Phase 1: Purposive sampling of first and second year Bachelor of Nursing students from 2012 to 2015 who were surveyed about their satisfaction with the model of learning. Bachelor of Nursing students were invited to complete a survey about their experience with the teaching and learning model employed in the SHHS in response to the question, 'What aspects of the SHHS are the most important to your success?' Phase 2: External clinical stakeholders working with nursing students in clinical placements were asked to respond to questions about the preparedness of students educated in this model to transition to employment. The evaluation showed that the SHHS model positively influenced students' satisfaction and confidence and increased the perception of clinicians of the work readiness of students.
Simulation is an important learning approach for the development of skills for healthcare practice. However, it remains under used in the education of mental health practitioners. This article examines the development, implementation and evaluation of a simulated learning experience for final year undergraduate BSc mental health nursing students in the UK. Scenarios involving managing care in an acute in patient ward and community older persons' team were designed to enable students to develop their complex decision making skills. An evaluation of the simulation experience was undertaken. This was informed by the principles of improvement science methodology and data was collected from the student participants using questionnaires. The findings indicated that simulation provided a realistic environment in which students were able to develop skills and manage clinical situations autonomously without fear of being assessed or making mistakes. Reflecting Dieckmann et al.'s (2007) position that simulation is a social situation in itself, the learning approach enabled mental health students to both experience the safety of the Higher Education setting and also the reality of clinical practice. Simulation may therefore provide an important tool to prepare students for the responsibilities of a qualified nurse.
Purpose:
The purpose of this study was to determine the stress level and coping strategies among undergraduate Saudi female nursing students during their clinical education.
Design and methods:
In this study, a descriptive correlational cross-sectional design was used. The Demographic Information Questionnaire, Perceived Stress Scale, and Coping Behavior Inventory were completed by 121 female Saudi undergraduate nursing students.
Findings:
The findings showed that stress from taking care of the patient subscale (M = 12.0, SD = 5.0) was ranked the highest mean among all perceived stress subscale scores. The most commonly used coping strategies among nursing students in clinical practice was a problem-solving strategy (M = 15.8, SD = 4.3).
Practice implications:
Facilitating the use of effective coping strategies in nursing students will promote quality of care for their patients.
Background
The article describes a mental health simulation that encourages student nurses to use therapeutic communication while assisting patients with mental illness in a clinical setting.
Method
A quasi-experimental, one group, pre–post test design using simulation during a mental health clinical orientation; data were analyzed using dependent t tests.
Results
There was significant improvement (p = .000) in student's self-reported confidence with their communication skills and knowledge following a mental health simulation experience using standardized patients.
Conclusions
Although more research is needed, a therapeutic communication mental health simulation given before students participating in their clinical experience should be integrated into undergraduate nursing education.
Simulation in undergraduate mental health nursing education is becoming more widely used as an educational strategy for teaching students skills in effective mental health nursing care. This article provides a review of the literature on the use of various simulation techniques utilized in undergraduate mental health nursing education. CINAHL and PubMed databases identified 429 potentially relevant articles published between April 2006 and April 2015. A total of 15 articles met criteria for inclusion in this review. Findings of these 15 articles indicate that simulation is effective for increasing students' skills in therapeutic communication, critical thinking, problem solving, decision making and risk assessment in mental health nursing practice. Also, simulation was found to help decrease student fear and anxiety of working with individuals who have mental health disorders, and promote greater self-confidence and understanding of mental illness. This articles offers implications for further research on the use of simulation as a teaching strategy in undergraduate mental health nursing education. © 2015 International Nursing Association for Clinical Simulation and Learning.
Background: In recent years, nursing education has undergone changes and restructuring due to changes that have occurred in clinical and academic settings. Currently, academic leaders are facing the challenges of an increasing number of students, the difficulty of recruiting teachers and preceptors to accompany students, and fewer clinical settings that can accommodate many interns at once. To come to terms with these changes, the idea of replacing clinical hours with simulation has emerged. On this issue, little conclusive data is available. The objective of this article is to clarify the contribution of simulation in clinical nursing education in preparation or substitution for clinical placement.
Methods: The CIHNAL, MedLine, and PubMed databases, and Google and Google Scholar search engines were consulted between to conduct a systematic review of the literature between 2008 and 2014. Thirty-three articles were selected.
Results: Students and teachers perceive the benefits of simulation as an adjunct to clinical placement in terms of effectiveness, self-confidence, and preparation for clinical practice. Substituting clinical placement with simulation does not seem to have a significant impact on clinical competency, critical thinking, knowledge acquisition, and self-confidence.
Conclusions: The findings question the very concept of substitution and suggest that the strengths of clinical exposure through both simulation and clinical placement should be highlighted.
Background: Undergraduate nursing students often view the mental health clinical rotation as a source of anxiety. This anxiety can have a negative influence on the establishment of a therapeutic relationship, jeopardize patient safety, and impact student well-being and success in the program. Incorporation of standardized patients (SPs) into the mental health specialty may be one strategy to decrease student anxiety and ultimately improve patient outcomes. Methods: This study utilized a quasi-experimental design to assess if SPs can reduce student anxiety as measured by an anxiety visual analog scale and the State-Trait Anxiety Inventory (STAI). A convenience sample of 69 senior level undergraduate nursing students participated in the study. Results/Conclusion: The results of the study revealed a statistically significant reduction in student anxiety after the interaction with the SP and provide preliminary support of incorporating SPs as a teaching methodology in the mental health specialty. © 2014 International Nursing Association for Clinical Simulation and Learning.
Background:
The use of standardized patients in deteriorating patient simulations adds realism that can be valuable for preparing nurse trainees for stress and enhancing their performance during actual patient deterioration. Emotional engagement resulting from increased fidelity can provide additional stress for student nurses with limited exposure to real patients. To determine the presence of increased stress with the standardized patient modality, this study compared the use of standardized patients (SP) with the use of high-fidelity simulators (HFS) during deteriorating patient simulations. Performance in managing deteriorating patients was also compared. It also explored student nurses' insights on the use of standardized patients and patient simulators in deteriorating patient simulations as preparation for clinical placement.
Methods:
Fifty-seven student nurses participated in a randomized controlled design study with pre- and post-tests to evaluate stress and performance in deteriorating patient simulations. Performance was assessed using the Rescuing A Patient in Deteriorating Situations (RAPIDS) rating tool. Stress was measured using salivary alpha-amylase levels. Fourteen participants who joined the randomized controlled component then participated in focus group discussions that elicited their insights on SP use in patient deterioration simulations.
Results:
Analysis of covariance (ANCOVA) results showed no significant difference (p=0.744) between the performance scores of the SP and HFS groups in managing deteriorating patients. Amylase levels were also not significantly different (p=0.317) between the two groups. Stress in simulation, awareness of patient interactions, and realism were the main themes that resulted from the thematic analysis.
Conclusions:
Performance and stress in deteriorating patient simulations with standardized patients did not vary from similar simulations using high-fidelity patient simulators. Data from focus group interviews, however, suggested that the use of standardized patients was perceived to be valuable in preparing students for actual patient deterioration management.
This paper explores the application of evaluation of high fidelity human patient (mannequin) simulation emerging in nursing education. The ramifications for use in mental health nursing are examined. A question is posed: Is high fidelity human patient (mannequin) simulation limited to being a “simulation of learning”?
Explicit research that traces learning outcomes from mannequin, to clinical practice and hence consumer outcomes, is absent in mental health. Piecing together research from psychology addressing cognitive load theory and considering the capacity for learners to imitate desired behaviour without experiencing deep learning, the possibility is real that simulation of learning is the outcome of high fidelity human patient (mannequin) simulation applications to mental health nursing.
Abstract Interviewing standardized patients (SPs) trained to model psychiatric disorders can promote student nurses' interview skills and therapeutic communication, while at the same time increasing their confidence and decreasing anxiety. From a constructivist view of education and Kolb's (1984; Experiential learning: Experience as the source of learning and development. Edgewood Cliffs, NJ: Prentice-Hall) theory of experiential learning, this article describes the development and use of SPs as a learning strategy. The use of SPs helps faculty in overcoming some of the challenges of competing for clinical sites and meeting objectives in limited clinical time. In this simulation, baccalaureate nursing students had the opportunity to interact with SPs, who had been trained to demonstrate symptoms of bipolar disorder, anxiety, and schizophrenia. During debriefing, students critiqued their performances, identifying strengths and weaknesses. The advantage to nursing students was the ability to improve their interviewing skills in a safe educational environment before encountering these patients in a clinical experience. Both faculty and student evaluations of this experience support its integration into psychiatric undergraduate courses.
To describe nursing students' experience of stress during clinical practice and evaluate the risk of stress in relation to the clinical setting characteristics and the organisation of the clinical education.
Stress during clinical practice is well documented, but there is a lack of knowledge concerning whether the clinical setting characteristics and the organisation of the education make a difference.
A cross-sectional study with evaluative design.
Data were collected by means of a numerical rating scale for the assessment of stress and questions about the clinical setting characteristics and the organisation of the education. One hundred and eighty-four students who had completed their final year on the nursing programme at three universities in Sweden were included.
Nearly half of the students (43%) experienced high level of stress during clinical practice. Measured by decision in the tree analysis, the absolute risk of stress was 57% in students with placements in hospital departments, as compared to 13% in students with placements in other clinical settings. The risk of stress increased to 71% if the students with placement in a hospital took the national clinical final examination. Performance of practice in a hospital department overcrowded with patients was also associated with increased risk of stress. The organisation of supervision and number of students at the clinical placement had an effect on the experience of stress, but did not prove to be risk factors in the analysis.
The risk of stress in nursing students during their clinical practice differs depending on clinical setting characteristics. The taking of the national clinical final examination could be a source of stress, but this requires further investigation.
It is important that supervisors are aware that students in hospital departments overcrowded with patients are at risk of stress and may have increased need of support.
Background
Baccalaureate student nurses entering their psychiatric or mental health clinical rotation are often fearful of their upcoming experience.
Method
To give students the opportunity to deal with some of these issues in a safe, nonthreatening environment, nursing faculty developed a Mental Health Simulation experience using two individual scenarios that included difficult-to-address behaviors and topics encountered in psychiatric as well as general hospital settings.
Results
A total of 54 students participated in this quality improvement educational project. Results showed overall decreases in anxiety levels and positive responses on all items in the Medical Education Technologies, Inc., Simulation Effectiveness Tool.
Conclusion
Simulation experiences in the psychiatric or mental health arena, both as participants and as observers, appeared to decrease students' anxiety about their upcoming clinical rotation and enhanced their clinical understanding.
Background
There is limited research into the effectiveness of standardized patient experiences (SPEs) to teach therapeutic communication skills in undergraduate psychiatric nursing students.
Method
A quasi-experimental, one-group, pre–post evaluation design was used to examine the effectiveness of the use of SPEs to teach therapeutic communication skills in psychiatric nursing. Study participants included 89 senior nursing students enrolled in a psychiatric nursing clinical course in a baccalaureate nursing program.
Results
Faculty provided formative evaluation on 14 criteria and group feedback early in the semester for students' first interaction with a standardized patient (SP). During a second intervention at the end of the semester, with an SP, summative feedback was used to evaluate the student using the same 14 criteria. Significant differences were noted in 12 of the 14 criteria demonstrating improvement in therapeutic communication skills.
Conclusion
Although further research is needed, this study suggests that the use of SPEs is an effective methodology for promoting therapeutic communication skills in undergraduate psychiatric nursing students.
To identify issues, from the emergency department clinicians' viewpoint, with the management of patients presenting to the emergency department with a mental illness.
Despite the introduction of several statewide and national initiatives, barriers remain affecting the care and management of consumers presenting with an mental illness to the emergency department. Improving the responsiveness of mental health services, including the provision of more efficient emergency responses for people in crisis, is a key goal. To achieve responsive mental health services in emergency departments, services are required to work together to ensure appropriate referrals between mainstream services and to those services developed to meet the unique needs of specific population groups.
A mixed method approach using surveys and focus groups.
Data were collected from patients with mental illness and their next of kin/carers, as well as staff working within the emergency department and the mental health services of the healthcare network.
The study found that there were inconsistencies and deficits in the educational preparation of emergency department staff to manage consumers presenting with mental illness. Further, the inadequate physical environment of the emergency department contributed to difficulties in assessing and managing this group of patients.
Staff members working within mental health services and the emergency department summarised the key improvement areas as the need for electronic case notes, improvements to the emergency department environment, mental health training, implementation of a referral service and increasing the number of staff.
Although initiatives have been implemented, there needs to be a greater focus on educating the staff in emergency departments in relation to the policies and strategies which aim to improve the care and management of patients presenting with a mental health problem.
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) found that 65% of medical sentinel events or medical errors are associated with communication breakdowns. In addition to the JCAHO, The Institute of Medicine, in their Core Competencies for health care professional education, recommend improvement in professional communication, collaboration, and a patient-centered approach to provide safety. Consistency of opportunities for students to practice their communication and collaboration skills is limited based on the variety of clinical experiences that are available. Simulation would provide consistency in students' experiences. Students can practice giving a structured report, providing and receiving peer feedback, and obtaining patient feedback in a safe setting through a simulation experience. A structured hand-off shift report using a technique such as SBAR communication has been found to improve patient safety in health care environments. This paper examines the implementation of a simulation experience for students taking a Mental Health course in a Bachelor of Science in Nursing (BSN) Program to support their practice of patient and professional communication, as well as, collaboration skills with a patient-centered approach using a standardized patient simulation.
This study aimed to identify the lifestyle behaviours of nursing students. The research tool was a 146-item questionnaire based upon the College Lifestyle and Attitudinal National survey. Most students considered their mental health as either good or very good. Those in the final year were more likely to rate their mental health poorly. Many experienced programme-related stressors including examinations and assignments and studies in general. More than one-third also reported stressors related to relationships with clinical staff and clinical assessment of competence. There is a concern that the added demands of modern nursing programmes place the student under considerably more pressure, because of competing demands. While many students talk to their peers or family, many do not and prefer rather to go it alone, with some choosing to escape through alcohol or drugs. The support and encouragement of healthy coping mechanisms among nursing students is paramount to ensure a healthy nursing workforce for the future. Nursing students support the mental and physical health of others, and therefore in many ways ought to a role model. Nurturing and supporting their mental health is crucial to the future of profession.
The Australian Mental Health Nurse Education Taskforce conducted a national examination of mental health content of preregistration nursing curricula in order to develop a framework for including mental health in future curricula. This paper presents the qualitative findings from national consultations about the framework. Content analysis of data was undertaken, and the findings show four key themes. First, the mental health content of curricula should be increased; second, overall mental health nursing leadership should be strengthened; third, mental health consumer participation should be increased in all aspects of curricula; and finally, a repository should be established for mental health teaching resources.
This article describes the results of a study into how first-year nursing students' perceptions of psychiatric patients and mental health care influence their choice of specialization in mental health care and future working in this sector.
A descriptive qualitative study design with semi-structured interviews. Respondents were selected through purposive sampling among all first-year bachelor students attending a Dutch school of nursing.
First-year nursing students have stereotype, mostly negative perceptions of psychiatric patients and mental health care. These perceptions strongly influence their future professional choices. The respondents provided various reasons for their decision not to major in mental health care, one of these being that the school did too little to counsel and inform them about mental health issues and a career in mental health care. As a result, their unrealistic perceptions prevailed.
If schools offering bachelor of nursing programmes do not sufficiently counsel and inform students about mental health care, students will leave school with their stereotype, negative perception of mental health care intact. Mental health care institutions will run a great risk of losing potentially good nurses.
The purpose of this paper is to review the use of simulation in education across the health professionals, to describe the development and implementation of innovative simulation techniques for an undergraduate psychiatric mental-health nursing course, and to identify lessons learned and future directions for successful simulation experiences in psychiatric nursing.
Government inquiries and workforce data continue to draw attention to the current and impending crisis in mental health nursing. While undergraduate nursing education has been found at least partially responsible for the negative attitudes nursing students tend to hold towards mental health nursing, clinical experience has been identified as a potential strategy in enhancing more positive attitudes. However, research to date has not focused on the impact of clinical experience on specific factors such as attitudes to mental health nursing to people experiencing mental illness and perceived preparedness for the mental health field. This quasi-experimental study measured changes in students' attitudes to the three factors, including satisfaction with clinical experience following a placement in mental health nursing. A questionnaire was administered to undergraduate nursing students on the first and last day of a mental health clinical placement. This, the first of a two-part paper, compares student responses over the two-time periods and describes satisfaction with the clinical experience. The findings suggest that clinical experience in mental health nursing experience can positively influence attitudes, preparedness for practice, and the popularity of mental health nursing. Satisfaction with clinical experience was also high.