Enhancing Mental Health Nursing Practicum with Clinical Simulation: A Comparison of Student Outcomes

Background: 

Opportunities for experiential mental health experiences in acute care settings are decreasing. In addition, acute care settings are restricting student practice opportunities thus, limiting the quality of learning experiences.  An excellent experiential alternative is the use of clinical simulation. Simulations can be used to supplement and enhance mental health nursing practicums by providing students with opportunities to interact, assess, and manage common mental health nursing challenges.

Objectives:     

1. The learner will be able to articulate the steps used to create an enhanced, comprehensive mental health simulation program, including topic selection and scenario development.
2. The learner will be able to compare and contrast student learning outcomes between a traditional mental health nursing practicum and the practicum enhanced with 31% clinical simulation.

Purpose:   

The purpose of the study was to compare student learning outcomes between two groups of students in the mental health nursing practicum, traditional practicum versus a practicum enhanced with 31% simulation.

Methods: 

The control group is a traditional clinical group, in which 8.8% (8 hours) of clinical hours are spent in simulation. The experimental group received 31% (28 hours) in simulation. Students were selected based on self-enrollment into practicum courses. The study was conducted over three semesters involving six clinical groups. The study assessed the students’ didactic course performance such as exam scores and ATI standardized test performance as student learning outcomes. 

The students in the experimental group experienced a series of seven simulations, progressing from an orientation to mental health nursing and assessment of common mental health disorders to a simulation depicting common adverse medication effects of antipsychotic and antidepressant medications. The students in the control group experienced two simulations, an orientation to mental health nursing and a simulation that could depict adverse medication effects or suicidal ideation.

Student learning outcomes were analyzed using matched pair t-tests and aggregate group data. Students were matched based on nursing grade point average (GPA) within and across semesters.

Results:   

Initial data reveals significant differences in both didactic course grades and standardized test performance of students in the experimental group with average nursing GPAs of 3.25 or lower and in students who had previously repeated nursing coursework, particularly on topics presented in the simulation scenarios found on the standardized test.

No significant difference was noted among students with nursing GPAs of 3.26 or higher on the didactic course grade or standardized testing performance.

Conclusions:

Increased clinical simulation, focused on common mental health nursing topics, improves student learning outcomes and performance in higher risk student populations, those with nursing GPAs of 3.25 or lower or who have previously repeated nursing coursework.