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Mental health simulation puts nursing students in patient’s shoes

Published January 03, 2014

NDSU nursing students eagerly put on the headphones and pressed play. After a few bars of the classic song “Soul Man,” the voice started softly before slowly growing more and more agitated.

“You can screw this up better than anyone else,” said the voice on the CD. “Do you have any idea how messed up you are?”

The words mimicked the distressing voices individuals with psychiatric disabilities sometimes hear. And the goal of the simulation was to have students walk away with a better understanding of how to treat patients with mental health issues.

The NDSU Nursing Department began the hearing voices simulation this academic year with help from a NDSU Development Foundation grant.

“The simulation was very beneficial in helping me to grasp a moment in a psychiatric patient’s mind,” said senior nursing student Nathan Mattson. “We gained valuable insight into how difficult tasks may be for patients with auditory disturbances, tasks we think may be rather easy.”

The simulation includes the CD and a worksheet of recommended tasks designed to put students in everyday situations, including a word find puzzle and a job interview. Becky McDaniel, assistant professor of nursing, added a visit to a doctor’s office and psychiatric house call to the mix to further challenge students.

All interactions during the simulation are over-the-top and exaggerated for effect, McDaniel said.

“Students will likely encounter a situation similar to this at one point or another in a clinical setting,” McDaniel said. “A lot of students are unsure of what to do or say in these situations. This gives them a chance to learn the best ways to interact with individuals dealing with mental health issues.”

A total of 28 students have been through the hearing voices simulation, designed by psychologist Pat Deegan. They listen to the disturbing voices CD as they maneuver through five stations.

At some point in the simulation, students are asked to go outside of the classroom to collect the make and model of cars and phone numbers for pizza restaurants in Fargo on a notepad. The demonstration drives home the point that seemingly easy tasks can become nearly impossible for patients hearing distressing voices.

“The benefits of having this type of simulation is that is shows us how to present ourselves as a nurse to those suffering from mental illnesses and gives us insight to know how difficult it can be to suffer from hearing voices,” said senior Kayli Gross. “Knowing how frustrating it can be to not remember what you are supposed to do or getting distracted by the voices will help me to put myself in a patient’s shoes so as a nurse I can be very calm and supportive.” 

The simulation’s unique station includes a trip to a darkened NDSU office suite decorated to mimic a patient’s home. Students are instructed to fold laundry, clean the floor and set a table as a strobe light flashes and the sounds of thunder rumble in the background. Plastic spiders are spread across the floor.

The experience overloads the senses.

In a debriefing following the simulation, Mattson said he felt himself getting more quiet and withdrawn as he attempted to focus on each task put in front of him.

“I will definitely try to be more patient to try to figure out what the underlying problem is without being judgmental,” he said. “Maybe there is something else going on with the patient that we can’t see or hear.”

The NDSU Nursing Department has used simulation technology since 2005, when a single adult simulator was the focal point of adult health nursing courses. Now, there are four high-tech simulators that mimic a male or female adult, a pregnant mother, an infant and a toddler. Students also participate in role-playing in classes to gain valuable experience in several different areas.

Students in a public health course replicate an at-home visit with an elderly woman in hazardous conditions, with a faculty member playing the role of the patient.

“It’s becoming an expectation in all health care diciplines that students work with this technology,” said Carla Gross, chair and associate professor of the nursing department. “It’s very important because it allows students to learn in a controlled and safe environment. They can practice nursing care in a high-risk situation and learn from any mistakes.”

Construction on a renovated space for simulations is scheduled to begin at Sudro Hall in January, Gross said. The plans include changing the current skills lab into a simulation lab, and constructing a storage area, debriefing room, a seven-bed skills lab and an area of offices. It’s slated to be finished by fall of 2014.

“The feedback that we’ve gotten from the students has been very positive,” McDaniel said. “They love the role playing part of it and they love the action of having faculty involved. They want more hands on experience. And that’s what this is giving them.”


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