Friday, 20 April 2018: 2:45 PM
Though integration of simulation to enhance clinical competencies has gained significant attention within the nursing literature over the past decade, minimal findings have been noted regarding the impact of a psychiatric mental health clinical simulation program on overall learning outcomes in a baccalaureate nursing program. In a recent study published by the National Council of State Boards of Nursing, Hayden, Smiley, Alexander, Kardong-Edgren, and Jeffries (2014) provided substantial evidence that standard clinical competencies and learning outcomes could be maintained with up to 50% of the traditional clinical experience being replaced by clinical simulation. This report, in combination with accelerated nursing student enrollments, increased competition for psychiatric clinical sites and limited access to experienced advanced practice psychiatric nurses to fulfill the clinical instructor role became the impetus for a pilot psychiatric mental health clinical hybrid program (PMHCHP) in a baccalaureate nursing program in the spring of 2015. In the spring of 2016, approval by the program’s Institutional Review Board was obtained to evaluate the impact of this PMHCHP on student learning outcomes and compare findings to students who did not receive this program in the previous three semesters.
The PMHCHP incorporated inpatient, community and clinical simulation with lab to create a comprehensive psychiatric mental health nursing clinical experience for senior nursing students. Thirty-six percent of required clinical hours were dedicated to simulation and lab experiences. Guidelines from the International Nursing Association for Clinical Simulation and Learning: INACSL Standards of Best Practice: Simulation (2013) assisted in the development of simulation components of the PMHCHP. These included the importance of actively addressing affective, cognitive and psychomotor domains of learning along with incorporation of high and low fidelity simulation opportunities for students. Core psychiatric mental health nursing competencies were also enhanced in the clinical simulation with lab component through self-reflective exercises and learning activities that addressed the impact of stigma, consumer and family perspectives, clinical interviewing skills, debriefing processes, suicide assessment and interventions, care of the actively psychotic patient, alcohol/opioid withdrawal, non-violent crisis intervention training and application of competencies to multiple clinical practice settings.
To evaluate the impact of this new clinical program on student learning outcomes, both quantitative and qualitative data were collected. A quasi-experimental posttest only design with nonequivalent groups was used as students could not logistically be randomly assigned to those who received the PMHCHP and those who did not receive the PMHCHP. A total of 524 senior nursing students participated in this study: 246 students who did not receive the PMHCHP were considered the “control group” and 278 students who received the PMHCHP were considered the “intervention group.” This research study reflects data obtained over a three year academic period from the fall, 2013 through the spring, 2016. Comparisons were made on individual students overall test averages, ATI content mastery computerized proctored assessments for mental health with achievement of proficiency level 0,1,2 or 3 and final grades. The Statistical Package for Social Sciences, Version 16.0 (SPSS, Chicago, IL) generated descriptive statistics to summarize data.
Three research questions were established to evaluate quantitative data collected. The first research question addressed whether students who received the PMHCHP scored differently on overall test averages than students who did not receive the PMHCHP. Descriptive statistics were obtained on minimum, maximum and mean scores as well as standard deviation. An independent sample t test was used. Results indicated no statistically significance (p=.260) between both groups on overall test averages. The second research question addressed whether students who received the PMHCHP scored differently on final grades compared to students who did not receive the PMHCHP. Descriptive statistics were obtained on minimum, maximum and mean scores as well as standard deviation. An independent sample t test was used. Results indicated statistically significant findings for students who received the PMHCHP (p=.017) on higher final grade averages. The final research question addressed whether students who received the PMHCHP scored differently on ATI proficiency level scores than students who did not receive the PMHCHP. This question was best answered with comparison of percentage reaching desired level. Findings reflected a 12.6% higher percentage of scores for ATI proficiency level 2 & 3 for students who received the PMHCHP.
The qualitative component of this research project examined narrative responses by students who participated in the PMHCHP to three questions that addressed their overall impressions of the psychiatric mental health clinical simulation and labs as an alternative learning experience. Several themes emerged including 1) feeling safer and more able to connect with peers in a smaller group setting, 2) the importance of engaging in mock clinical experiences in a non-judgmental, supportive learning environment to reduce anxiety and enhance learning, 3) the value of mock interviews, role plays, crisis intervention training and case presentations in building their sense of competency and confidence in providing safe care, 4) the importance of taking the time to reflect on own personal perspectives with mental health issues and how this may impact patient care, and 5) the opportunity to develop empathy for those who suffer from mental illness through open discussion, documentaries, movies and active engagement with consumers.
In conclusion, in lieu of increased patient acuity, limited clinical sites and limited seasoned clinical faculty, schools of nursing are challenged to create innovative alternative experiential clinical opportunities to ensure students meet learning outcomes. The findings of this research study suggest that the implementation of a comprehensive PMHCHP that integrates multiple opportunities for simulated and lab experiences in combination with traditional direct care clinical experiences can effectively assist students with achieving and potentially strengthening learning outcomes necessary in a psychiatric mental health nursing course. This is consistent with other studies which have reported similar learning outcomes when examining the impact of replacing a percentage of traditional clinical hours with clinical simulation. Continued research and dialogue within the academic nursing community are warranted to build evidence-based models for student clinical experiences.
The PMHCHP incorporated inpatient, community and clinical simulation with lab to create a comprehensive psychiatric mental health nursing clinical experience for senior nursing students. Thirty-six percent of required clinical hours were dedicated to simulation and lab experiences. Guidelines from the International Nursing Association for Clinical Simulation and Learning: INACSL Standards of Best Practice: Simulation (2013) assisted in the development of simulation components of the PMHCHP. These included the importance of actively addressing affective, cognitive and psychomotor domains of learning along with incorporation of high and low fidelity simulation opportunities for students. Core psychiatric mental health nursing competencies were also enhanced in the clinical simulation with lab component through self-reflective exercises and learning activities that addressed the impact of stigma, consumer and family perspectives, clinical interviewing skills, debriefing processes, suicide assessment and interventions, care of the actively psychotic patient, alcohol/opioid withdrawal, non-violent crisis intervention training and application of competencies to multiple clinical practice settings.
To evaluate the impact of this new clinical program on student learning outcomes, both quantitative and qualitative data were collected. A quasi-experimental posttest only design with nonequivalent groups was used as students could not logistically be randomly assigned to those who received the PMHCHP and those who did not receive the PMHCHP. A total of 524 senior nursing students participated in this study: 246 students who did not receive the PMHCHP were considered the “control group” and 278 students who received the PMHCHP were considered the “intervention group.” This research study reflects data obtained over a three year academic period from the fall, 2013 through the spring, 2016. Comparisons were made on individual students overall test averages, ATI content mastery computerized proctored assessments for mental health with achievement of proficiency level 0,1,2 or 3 and final grades. The Statistical Package for Social Sciences, Version 16.0 (SPSS, Chicago, IL) generated descriptive statistics to summarize data.
Three research questions were established to evaluate quantitative data collected. The first research question addressed whether students who received the PMHCHP scored differently on overall test averages than students who did not receive the PMHCHP. Descriptive statistics were obtained on minimum, maximum and mean scores as well as standard deviation. An independent sample t test was used. Results indicated no statistically significance (p=.260) between both groups on overall test averages. The second research question addressed whether students who received the PMHCHP scored differently on final grades compared to students who did not receive the PMHCHP. Descriptive statistics were obtained on minimum, maximum and mean scores as well as standard deviation. An independent sample t test was used. Results indicated statistically significant findings for students who received the PMHCHP (p=.017) on higher final grade averages. The final research question addressed whether students who received the PMHCHP scored differently on ATI proficiency level scores than students who did not receive the PMHCHP. This question was best answered with comparison of percentage reaching desired level. Findings reflected a 12.6% higher percentage of scores for ATI proficiency level 2 & 3 for students who received the PMHCHP.
The qualitative component of this research project examined narrative responses by students who participated in the PMHCHP to three questions that addressed their overall impressions of the psychiatric mental health clinical simulation and labs as an alternative learning experience. Several themes emerged including 1) feeling safer and more able to connect with peers in a smaller group setting, 2) the importance of engaging in mock clinical experiences in a non-judgmental, supportive learning environment to reduce anxiety and enhance learning, 3) the value of mock interviews, role plays, crisis intervention training and case presentations in building their sense of competency and confidence in providing safe care, 4) the importance of taking the time to reflect on own personal perspectives with mental health issues and how this may impact patient care, and 5) the opportunity to develop empathy for those who suffer from mental illness through open discussion, documentaries, movies and active engagement with consumers.
In conclusion, in lieu of increased patient acuity, limited clinical sites and limited seasoned clinical faculty, schools of nursing are challenged to create innovative alternative experiential clinical opportunities to ensure students meet learning outcomes. The findings of this research study suggest that the implementation of a comprehensive PMHCHP that integrates multiple opportunities for simulated and lab experiences in combination with traditional direct care clinical experiences can effectively assist students with achieving and potentially strengthening learning outcomes necessary in a psychiatric mental health nursing course. This is consistent with other studies which have reported similar learning outcomes when examining the impact of replacing a percentage of traditional clinical hours with clinical simulation. Continued research and dialogue within the academic nursing community are warranted to build evidence-based models for student clinical experiences.