Student nurses in a mental health course often approach the experience with trepidation. Psychiatric/psychological diagnoses address maladaptive behaviors and unregulated emotions. Therefore, mental health clinical rotations frequently lead to high anxiety, fear, negative attitudes, and difficulty with patient communication. This article by Kathy Sokol, will explore the use and training of standardized patients in mental health simulations, which are crucial for helping to educate and train new clinical professionals.
Nursing Simulation strives to address the concerns of clinical faculty and learners assigned to mental health rotations. Ideal simulation-based experiences (SBE) include the care of patients across their lifespan. Mental health-themed SBEs can address patients of all ages. Additionally, SBEs allow learners to perform a mental health assessment, administer medications, and provide interventions not always permitted with live patients.
Clinical Simulations that address psychological disorders are ideal venues for Standardized Patients (SP). SPs realistically interact with learners to duplicate behaviors found in psychiatric patients and can change their facial expressions to fit the prescribed mood. However, careful SP preparation is necessary to achieve good outcomes and maintain participant focus.
Mental Health Patient Disorders Cause Anxiety in Many Students
Because patients with a mental health diagnosis may have strange, unpredictable behaviors, students often shy away from clinical interaction. The use of SPs and structured dialogue helps to reduce learner hesitation. The Simulation Educator trains SPs to ensure scenario validity and rigor. The SP must understand how a patient with psychological issues would behave. Scripts written by subject matter experts help the SP anticipate questions from learners and guide their responses.
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Patients admitted to a mental health facility for treatment may hesitate to work with learners and demonstrate negative responses to learners’ attempts at interaction. Due to privacy and legal concerns, psychiatric hospitals and treatment centers exercise caution when approached by schools for clinical placement. Some only allow students to stand aside and observe patient care.
Many facilities have cut clinical hours to decrease disruption in routines caused by the presence of school visitors. These restrictions limit face-to-face time and stifle opportunities for student nurses to practice therapeutic intervention. Mental health Nursing Simulations eliminate the problem of tightly regulated clinical placements. Clinical Simulation is limited only by the course objectives. Learners can experience diverse patient disorders based on the scenario.
Standardized Patients Can Create Realistic – But Safe – Experiences
Clinical Simulation has used standardized patients (SPs) for decades. A Simulation Educator may recruit individuals from the general public or within an academic or medical environment. For instance, the School of Medicine may recruit SPs from the Psychology Department for mental health scenarios. The Simulation Educator considers the SP applicant’s personality, communication style, and attitude. A successful Clinical Simulation relies on how well the SP fits the desired role they will play. Learners respond more positively toward SPs who portray believable characters.
SPs are usually contracted paid actors, although schools may use volunteers as long as they follow strict requirements for participation. SPs adhere to carefully written scripts authored by the simulation subject matter expert. SPs must clearly understand their role in the scenario and be able to react to learners as instructed. For instance, the SP may be told to get frustrated when the learner uses poor communication. Or, the scriptwriter might tell the SP to stand up and pace the room to cue the learner to use specific calming techniques.
SPs learn to behave as a patient would in a particular healthcare situation. Details like how to walk, where to sit/stand, what they will wear, if physical contact with the learner will occur, and how much input they are allowed to provide are part of orientation. SPs receive clear expectations and understand objectives before the start of the scenario. The SP must be careful to reconstruct a realistic clinical situation and not threaten the learner’s safety. SPs must also set aside their prejudices towards the patients they portray. Improvisation is discouraged as this misdirects the action and impacts the objectives.
Mental health care workers may, over time, experience less empathy towards patients with behavioral disorders. Daily interaction with these individuals means staff must constantly monitor their emotions and how they feel. An expected professional demeanor can result in staff frustration.
Student nurses can pick up on and misunderstand these actions and attitudes towards patients. Individual prejudice can result when students are assigned to care for the same patients. SPs train on how to help participants communicate with the patient. During pre-brief, SPs receive cues for the feedback they will give learners, like how they (the patient) feel or their unmet needs. Since student nurses often report a sense of poor performance in mental health scenarios, each learner should play an interactive role in each experience. Active participation within simulation enables learners to practice therapeutic communication with the patient.
Standardized Patients Also Play an Essential Role in Debriefing
Debrief is when most learning takes place. This phase is when participants are encouraged to discuss their thoughts, emotions, and impressions of the simulation. Learners need immediate feedback. SPs play a vital role in debrief to provide helpful feedback. The SP can revisit how they, as the patient, felt throughout the scenario.
Patients with a mental health diagnosis rely on strong therapeutic communication between themselves and the nurse. Throughout their clinical rotations, student nurses try different methods, such as open-ended questions and guided communication, to establish rapport with their patients. A mental health SP can tell learners which communication techniques made them feel listened to and respected and which blocked dialogue. Participants can then dive deeper into their clinical actions through reflection and review.
The Simulation Expert provides SPs with a checklist to help them evaluate learner performance throughout the Clinical Simulation. Part of SP training includes correctly completing the checklist to assess learner actions. While the Simulation Expert/Facilitator submits the final learner evaluation, the SP provides valuable input based on their observations during the simulation.
Nursing Simulation can effectively introduce learners to the unique care of patients with psychological diagnoses. SPs add the human element necessary to give the scenario greater realism. Well-trained SPs are essential to elevate the experience so participants engage in critical thought to help prepare learners for their professional role as nurses.
Enhancing Healthcare Simulation-Based Education with High-Fidelity Standardized Patients
