Project Description: The PsycSim project replaced traditional MH clinical with 50% simulation targeting critical, MH learning competenices and optimal use of dwindling clinical placement sites. The project was divided into 3 phases. Phase 1: Development July-Oct 2015. Faculty members met with the director of behavioral health and MH nurses at the largest health system in the local area. Directors, nurses and faculty collaborated to develop a comprehensive simulation plan based on expected student outcomes, population health needs and health system priorities. Therapeutic communication, assessment and evidence-based interventions such as risk identification, crisis management, screening brief intervention, referral to treatment (SBIRT), and motivational interviewing were included in the scenarios. Scenarios were reviewed by health system nurses for validity and relevancy. Phase 2: Course Preparation Aug-Dec 2015. Faculty members created schedules to rotate the first cohort of 102 students (including regional campuses) between simulation and traditional clinical settings. The rotation plan allowed for 2 student groups to utilize 1 clinical site thereby optimizing clinical placement capacity. Faculty revised clinical assignments to reflect the new rotation schedule and trained the simulation coordinator and clinical faculty members in PsychSim methods and best practices in simulation education. Phase 3: Implementation Jan 2016- May 2017: In phase 3, 102 undergraduate MH nursing students participated in PsycSim every week. The simulation team and MH faculty members met regularly to discuss needed revisions in rotation schedules, simulation processes, scenarios, or technical issues and revise the procedures appropriately. The team utilized a Plan-Do-Study-Act framework for implementation and project evaluation.
Evaluation Approach: The project evaluation included formative and summative quantitative and qualitative student and faculty surveys using the Client Simulation Lab Questionnaire (CSLQ-S). The CSLQ-S measures student perceptions of simulation experiences. Group-level, student performance data was compared to data from previous semesters for benchmarking. Final faculty and student evaluations included the Clinical Learning Environment Comparison Survey (CLECS) (Leighton, 2015).
Feedback and Results: Faculty leveraged expertise gained from participation in the National Council of State Boards of Nursing landmark Simulation Study (NCSBN, 2014) and expanded the proportion of simulation in the undergraduate MH clinical course from 8% to 50%. At baseline, 8-10 students per week participated in MH nursing simulation replacing 1 of 12 traditional clinical days per semester. PsychSim increased the MH nursing simulation capacity to 102 students per week, effectively replacing 6 of the 12 traditional clinical days. The strategy doubled the number of students able to use each clinical placement site through a rotation schedule, and tripled the number of simulation experiences available to students.
Students reported that simulation scenarios prepared them to interact with mental health patients and intervene using evidence-based interventions for patient anxiety, depressive symptoms, and situational challenges. On the CLECS, students scored the simulation portion of their clinical experience as better meeting their clinical objectives compared to traditional clinical placement. Clinical faculty who predominantly taught in the simulation area believed that simulation better prepared students for practice, while those teaching predominantly in the traditional clinical setting preferred the traditional setting for meeting learning objectives. Both groups of clinical faculty noted that motivational interviewing and other simulation experiences increased students’ confidence and professionalism in the clinical area.
Discussion: The traditional method of educating nurses by taking a group of 8-10 students to a clinical site is unsustainable because of changes in health care delivery patterns and competition for clinical sites. Only by investing in innovative solutions including simulation expansion to compensate for clinical placement insufficiency will the IOM (2010) goals be realized. The project also represents a substantive curriculum enhancement and builds on the findings from the NCSBN simulation study (2014). PsycSim provides an individualized, innovative educational experience wherein students are systematically prepared for the care complexities they will encounter upon graduation. Such practice-ready BSN graduates are greatly needed in a state with an overall health care grade of “F” and a national rank for health of 45 (United Health Foundation, 2012).