To compound the problem, there are limited psychiatric settings for students to obtain their clinical experience due to the closure of psychiatric institutions over the years and the increased competition with other nursing schools for limited clinical placements. Additionally, patient safety initiatives at acute facilities have reduced the number of nursing students permitted on a patient unit at one time which creates fewer educational opportunities (Hayden, Smiley, Alexander, Kardong-Edgren & Jeffries, 2014).
To meet curriculum objectives, live actors are frequently used as patients in simulation (Keltner, Grant, McLernon, 2011). Live actors have also been used in response to the growing number of patients with a psychiatric diagnosis being treated on medical surgical floors at Birmingham VA Medical Center. The US Department of Veterans Affairs Nursing Academy (VANA) in a joint effort between the Birmingham VA Medical Center and the UAB School of Nursing, developed mental health simulation videos with live actors. Among the top 10 diagnoses treated on the medical surgical floors, three are related to mental health (i.e. posttraumatic stress disorder, substance abuse, schizophrenia) (Keltner, Grant, McLernon, 2011).
According to Webster (2011), patients with mental illness are often unable to clearly express their needs due to their illness or barriers related stigma. Furthermore, student anxiety may create additional challenges that impact the development of the therapeutic relationship. Although communication is not the only focus of patient-centered care, it provides a strong foundation for the provision of care that recognizes and includes the patient as a full partner in his or her care. The possession of effective communication and continuous assessment of one’s own communication techniques is essential. The nursing student who does not possess these skills will be challenged with eliciting patient values and collaborating with the patient to plan and provide quality care.
Incorporating actors as psychiatric patients is useful because nursing students have an opportunity to improve their skills in a safe and nonthreatening environment. This teaching strategy represents an opportunity for immersive, interactive and reflective simulation experiences to enhance nurses’ clinical practice (Keltner, Grant, McLernon, 2013). Although the literature contains ample examples of simulations used to teach psychomotor skills, studies involving the use of live actors to teach therapeutic communication is limited (Webster, 2013).
Purpose: To meet specific learning objectives in a baccalaureate nursing curriculum, a five week psychiatric experiential experience was provided to the nursing students in a simulated apartment. The aim was to identify the lived experience of nursing students experience with live actors. Second, to identify if skills learned in simulation are transferred to students’ capstone hospital experience (120 hours clinical with a hospital preceptor). Third, to determine the effectiveness of this nontraditional teaching strategy.
Objectives: Participants will be able to:
1. Understand the sequential approach to the development of live actors in psychiatric simulation.
2. Identify how to institute evidenced based changes in a baccalaureate nursing curriculum.
3. Understand how to incorporate simulation with live actors in the psychiatric clinical component of the curriculum.
Design and Method: This IRB approved study was conceptually orientated in Hildegard Peplau’s theory of Interpersonal Relations. Using a qualitative design, seven senior nursing students from a traditional baccalaureate program, were asked to transition from a detached observer to an involved performer in a simulated experiential setting. The students were asked to complete an anonymous, open-ended questionnaire after their simulation experience and again after their post capstone experience. Seven textual responses were analyzed. An adaptation of Colaizzi’s (1978) method of data analysis was used to extract and describe themes.
Findings: Four thematic categories that emerged from the data included: “Change in Expectations” “Improved Therapeutic Communication”, “Strengthened Skills” and “Recommended for All”. Samples from the thematic analysis are the following: “Simulation has taught me how to provide care on such a different level”, “Allowed me to communicate with confidence and empathy” and “Perhaps it would be great experience if nursing students are able to have both experiences; the clinical setting and the experiential learning with live actors. There should be a lab or a class devoted to therapeutic communication perhaps at the start of the nursing program.” This thematic analysis provided insight into a contemporary experiential experience for senior nursing students in a baccalaureate accredited nursing program.
Conclusions: The results from this research study provide an increased understanding of nursing students’ perceptions of this specific educational strategy; live actors in simulation. The students found their overall experience to be positive. Specifically, first, the interviewer having the ability to call a “time out” during an interview to request feedback from peers and faculty. Second, peers could also call a “time out” to assist the interviewer who might have not have inquired about essential information during the interview. Third, students had an opportunity to practice restraint and seclusion documentation which is often not permitted in the hospital setting. Fourth, students were able to conduct an environmental rounds in an apartment constructed specifically for the purpose of conducting simulation with live actors. Lastly, students reflected on their experiential experience in weekly reflection papers with an underline focus to increase their level of self-awareness about their thoughts, emotions and behaviors in simulation.
The faculty found this educational strategy to exceed expectations. The results of this research study has assisted to improve upon the experiential experience for future nursing students at the College. Nursing students entering the Fall 2017 academic semester will all have one day of simulation with live actors along with four weeks of clinical in a hospital setting. Additionally, there is a proposal to move the nursing psychiatric course from the last semester of senior year to the first semester of Junior year. This course was recommended earlier as study participants identified a need to improve their therapeutic communication skills as well as interviewing skills earlier in the nursing curriculum.
Clinical Relevance: Results of this research study provide an evidence based determination with regard to a contemporary and alternative form of learning to the traditional clinical setting. This intensive experiential experience addresses the following QSEN competencies: patient centered care, team work and collaboration, quality improvement and safety. Live actors in psych simulation creates a safe environment for nursing students to improve upon their communication skills with patients. This is critical as therapeutic communication is an essential ingredient to improved patient outcomes.
The results have also changed nursing education’s practicum requirement for psychiatry and have the potential to change other specialties like palliative care. Palliative care is a sensitive area that presents its own unique challenges with regard to end of life care.
The blending of art and science with live actors in simulation holds great promise for nursing as a profession whether locally or internationally. In addition to the college level, live actors in simulation can be incorporated on a nursing graduate level as well as the orientation of a newly hired registered nurses in hospitals.