Educators have encountered challenges in teaching concepts of personality disorders to student nurses. Similar to many mental health disorders, knowledge transformation about personality disorders requires the learner to assimilate all learning taxonomies from recall to synthesis in a brief period of time, usually without the benefit of interaction with individuals who display characteristics of personality disorders. While no literature described the use of simulation to illustrate interaction with individuals with personality disorders, evidence suggests simulation experiences with standardized patient actors can provide realistic situations of mental health disorders. In particular, when learning about mental health, learners explore and integrate skills in assessment, communication, self-awareness, and professional growth in a safe setting (Witt et al., 2018). Furthermore, the debriefing process is an essential aspect of active engagement in simulation learning, allowing learners to employ reflective processes that help connect thinking with action and also help transfer learning from one environment to another to inform future patient encounters (Dreifuerst, 2015). Simulation was therefore identified as an ideal strategy for depicting personality disorders and engaging the learners. This particular learning experience was based upon Mezirow’s (1991) theory of transformative learning, which explains that learners use prior knowledge to interpret a revised meaning of their own experience, perhaps taking them out of their comfort zone, yet providing guidance for future action. This was significant for the current simulation in that the process required learners’ active engagement in their learning, using both discourse and critical reflection to gain deeper meaning and entertain additional perspectives about the topic of personality disorders.
The purpose of the simulation was student nurse engagement in transformative learning about personality disorders. This was accomplished via interaction in small groups with individuals (standardized patients) who portrayed selected personality disorders, and participation in a subsequent debriefing process and reflective writing assignment. The simulation was arranged in a casual community setting to illustrate that personality disorders are manifest everywhere and to facilitate student transfer of learning from a life-like situation that one might experience anywhere to other types of situations. The simulation sessions were held on December 3, 2018, with 37 students participating. Of 35 student respondents on the evaluation of the experience, 91.43% agreed their confidence in the skill area improved as a result of the simulation. All respondents reported the debriefing process facilitated self-reflection. Content analysis of narrative comments about the debrief illustrated the following common themes: involved all learners in interactive discussion about the conversations and students’ experiences and thoughts, enhanced knowledge of personality disorders, gained perspective of what was done well and what could have been done differently, and realized encounters occur with many people in life who display these personalities.
Content analysis of the reflective writing assignment revealed the following themes about the meaning for students: felt prepared to communicate effectively with someone with a personality disorder, recognized these disorders are present in our society, applied learning to a real-life scenario, realized these experiences with personality disorders will occur outside the hospital, and identified nurses need to balance empathy with caution in care of people in society.
Based on deeper understanding of the complexity of personality disorders, student nurses were prepared to augment their professional development in the nursing role as they discussed how they could apply concepts and meanings gained from this experience not only to clinical situations, but also to life in the larger community.
Implications include gathering further evidence about the effectiveness for student learning when using simulations with standardized patients depicting mental health disorders in life-like community settings. Consider expanding such simulations to include standardized patient portrayal of individuals with acute or chronic mental illness along with their family members or care givers in their homes. Explore further application of Mezirow's transformative learning theory to simulation experiences, especially as related to psychiatric/mental health nursing.
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