Using Simulation to Combine Mental Health and Adult Health in an Unfolding Case Study

New graduate nurses are expected to recognize and respond in an appropriate manner to deteriorating patient conditions (Fisher & King, 2013). In nursing practice, nurses have to learn to manage physical issues along with mental health issues. Warren et. al (2016) indicated that psychiatric care in emergency departments in the United States increased from 5.4% to 12.5% within a seven year period. Simulation is a strategy used by educators that allows students to apply what they have learned in a controlled environment without causing harm to actual patients if mistakes are made (Eade & Winter, 2017). The Adult Health and Mental Health Nursing Professors at a small, rural university decided to collaborate to develop a simulation scenario that integrated a patient experiencing both mental health and physical health issues to better prepare the students for realistic practice.

The purpose of this simulation was to provide first semester senior nursing students the opportunity to critically think through an unfolding case study that transitioned from a mental health situation to a medical situation. There were six scenarios within the unfolding case study. The nursing student was responsible for assessing the patient, communicating with the patient, caregiver, and healthcare provider when indicated and making decisions regarding the patient’s care specific to the simulation story line. The first scenario began with a patient who came into the emergency room depressed over the death of her daughter and was exhibiting self-harm behavior. The second scenario continued with the patient being placed on suicide precautions with an assigned sitter. The sitter was playing loud music which was agitating the patient. The next scenario involved a suicide attempt by the patient who then had to be revived. The following situation included being able to identify lithium toxicity and aspiration pneumonia. The patient developed sepsis in the next scenario and the simulation terminated with the patient’s diagnosis of Disseminated Intravascular Coagulation. A faculty member played the role of the patient in the first three scenarios and a high-fidelity manikin was utilized as the patient in the final three scenarios.

The case study took place in a room with a two way mirror and a speaker. There were 12 nursing students that were divided into two groups of six. This offered a different student the chance to be the nurse in a simulation. One group came in the morning and the second group attended in the afternoon. Each group of students were able to view their peers and follow along with each development. The students utilized critical thinking and communication skills while increasing their confidence levels.

After the simulation, the students completed a student evaluation of simulation/clinical session evaluation. The students rated the simulation exercise with an average of 8.33 on a one to ten scale. The comments were overall positive about their learning experience and the case study.