College of Nursing on cutting edge of psychiatric simulation

Villanova, PA, September 1, 2010 — With mental disorders being so common in the United States and around the world—one in four American adults or approximately 58 million people have a diagnosable mental disorder in a given year according to the National Institute of Mental Health (NIMH)—the impact on nursing is significant. The weight of more serious illness is seen in about 1 in 17 of those affected. Mental disorders cross all age groups and cultures and are seen in all care settings. The Villanova University College of Nursing recently implemented an innovative new clinical simulation for second semester junior nursing students to increase their understanding of the patient experience for those with more severe disease which includes hearing distressing voices. Student Erika Clark calls it an "eye-opener." "Understanding your patient's perspective is necessary for quality nursing care," she notes.

Targeting the care of patients who hear distressing voices (for instance, those with schizophrenia affecting about 1% of Americans, according to NIMH statistics), College faculty and associate professors Patricia K. Bradley, PhD, RN and Gale Robinson-Smith, PhD, RN, along with consultant Colleen Meakim, MSN, RN, director of the College's Learning Resource Center, applied for and received a University VITAL (Villanova Institute for Teaching and Learning) grant to implement the Hearing Voices That Are Distressing (HVTAD) experience with their undergraduate Psychiatric Nursing clinical students starting this fall semester. The HVTAD experience, which builds on the students' previous classroom learning, has also been used elsewhere with first responders such as EMTs and police. "The College of Nursing is among the first nursing schools in the United States and Canada to use the simulation," says Dr. Robinson-Smith.

"The HVTAD Program is a training and curriculum package that provides a simulation experience for undergraduate nursing students," explains Meakim. Students are instructed in use of the headphones and the MP3 player recording and how the simulation will be conducted, as well as the location of a "safe zone" where they can adjust their headphones or seek assistance from faculty if they need to briefly step away from the immediate sensory experience. The students use headphones to listen to a specially designed recording which simulates auditory hallucinations as they perform a number of tasks at various workstations. They role play with "standardized professionals" (non-nursing students trained to act as mental health professionals) where they must participate in an evaluation interview with an emergency department psychiatrist, complete cognitive testing and interact while in a community day program activity. The simulation experience is followed by a debriefing and discussion period.

Dr. Bradley offers, "Through the simulation experience students increase their empathy and understanding of the lived-experience of psychiatric disability." Student Shazi Khan recalls feeling "guarded and distracted" during his simulation period. A major objective of the simulation is for students to learn more effective ways of helping people who hear distressing voices. Classmate J. R. Beshore summarizes the impact of his scenarios, "I left the simulation with a deeper understanding and appreciation for what these patients live with, which will allow me to express true empathy when working with them. Every nursing student should have this experience." Lauren Dornin agrees, "Regardless of their message, encouraging or degrading, the voices greatly impacted my concentration and overall sense of well-being. This was an invaluable experience and will allow me to better relate to and empathize with mental health patients in the future."

Attempting to write while simulating patient conditions
Answering questions while simulating patient conditions.

Nursing students in their psychiatric nursing clinical practicum learn ways of helping people who hear distressing voices as they participate in a clinical simulation of auditory hallucinations. Here they are distracted by voices through the headphones and struggle to complete tasks as they undergoing cognitive testing and an evaluation by a psychiatrist in a simulated emergency department scenario, mimicking a patient experience.