The distress of voice-hearing: The use of simulation for awareness, understanding and communication skill development in undergraduate nursing education

Psychologists' experience of working with people who hear voices and their views on the idea of voice simulation training: A qualitative study

OBJECTIVES

Research indicates psychologists typically lack subjective understanding of voice hearing. Voice hearing simulation training has potential to improve understanding, empathy and confidence among clinicians, but psychologists have had limited input into its development. This study investigated psychologists' and a psychotherapist's clinical experience of working with people who hear voices and their views and recommendations for voice hearing simulation training.

DESIGN

This was a qualitative study.

METHODS

Clinical psychologists and one psychotherapist (N = 17) participated in semi-structured interviews. Thematic analysis was used to analyse transcribed data.

RESULTS

The Clinical Experience theme comprised of subthemes Barriers to engagement, Diversity of voice hearing experiences, Lack of subjective understanding, Curiosity about voice hearing, Empathy for voice hearers, Using personal experiences to relate to voices, Clinical experience increases knowledge, Importance of supervision and colleague's support, Benefits of experiential training, Limited training in non-psychosis settings and Clinical experience increases confidence. The Views on Voice Hearing Simulation Training theme comprised of subthemes Improves subjective understanding, Concern about distress, Discomfort as a strength of voice hearing simulations, Artificiality of simulation, Increases empathy and Over-estimation of understanding. The Recommendations theme comprised of subthemes Discuss artificiality, Co-production, Promote voice diversity, Support staff and Maximise inclusivity.

CONCLUSIONS

Findings indicate that clinical experience improves psychologists' confidence and knowledge, yet participants reported a lack of subjective understanding of voice hearing. Co-produced simulation training between individuals who hear voices and clinicians was anticipated to improve subjective understanding, empathy and therapeutic relationships, which could support a range of staff and improve quality of care delivered.

Psychosocial interprofessional perinatal education: Design and evaluation of an interprofessional learning experience to improve students' collaboration skills in perinatal mental health

BACKGROUND

Perinatal mental health disorders are one of the leading causes of maternal illness and suffering and care and services need to be well coordinated by an interprofessional team who are skilled in working collaboratively.

AIM

The aim of this paper is to describe the design and evaluation of an innovative interprofessional education initiative to increase midwives and other health professional students' knowledge and skills in caring collaboratively for women with psychosocial issues in the perinatal period, including women experiencing domestic and family violence.

METHODS

The Psychosocial Interprofessional Perinatal Education workshop was designed for midwifery, psychology, social work and medical students. It provided a simulated learning experience with case studies based on real life situations. Students undertook pre and post surveys to measure changes in students' perceptions of interprofessional collaboration and their experiences of participating in the interprofessional simulation-based learning activity. Quantitative survey data were analysed using paired t-tests and a qualitative content analysis was undertaken on the open-ended questions in the survey.

FINDINGS

Comparison of pre and post surveys found students from all disciplines reported feeling more confident working interprofessionally following the workshop. The following categories were generated from analysis of the open ended survey data: Greater understanding of each others' roles; Recognising benefits of interprofessional collaboration; Building on sense of professional identity; Respecting each other and creating a level playing field; and Filling a pedagogical gap.

CONCLUSION

Through this innovative, simulated interprofessional education workshop students developed skills essential for future collaborative practice to support women and families experiencing psychosocial distress.

Psychiatric nurse's perceptions of their interactions with people who hear voices: A qualitative systematic review and thematic analysis

WHAT IS KNOWN ON THE SUBJECT?: There is no qualitative systematic review of nurses' perceptions of their interactions with people hearing voices. There are some studies exploring the interventions provided by community psychiatric nurses to people hearing voices; these give a sense of what interactions may contain. WHAT THE PAPER ADDS TO THE EXISTING KNOWLEDGE?: Nurses across both community and inpatient mental healthcare settings feel uncertain about how to interact with people hearing voices, sometimes feeling like they can do little to help. Their interactions are affected by the workplace culture, education and training and concern for their own safety. Nurses rely on a therapeutic relationship for all interactions. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This is an under investigated area of mental healthcare. None the less this qualitative systematic review highlights that nurses are unclear about how to interact with service users hearing voices with the resultant outcome that service users in great distress may only be receiving minimal benefit from their interactions with the nurses caring for them. ABSTRACT: Aims and Objectives The aim of this qualitative systematic review and thematic analysis was to identify and synthesize results from studies that explored psychiatric nurses' perceptions of their interactions with service users experiencing auditory hallucinations (hearing voices). Method Qualitative systematic review and thematic analysis. Results Five studies that met the inclusion criteria were identified. Nurses reported that they felt uncertain about what to do for service users hearing voices, struggled to have interactions with voice hearers, but greatly valued the therapeutic relationship with service users. Nurses also reported that they required more education and training on how to interact effectively with people hearing voices. Finally, various workplace challenges were identified as an important factor mediating nurse interaction with service users hearing voices. Discussion Existing evidence shows that nurses lack clarity about how they can interact effectively and in a way that helps service users who are hearing voices. Significant barriers that they must overcome in order to be more certain of their role in caring for people hearing voices are difficult to engage service users and workplace challenges that were not conducive to helpful interactions and conversations. Implications for Practice Nurses caring for people hearing voices require more and better education and training with a view to them becoming more confident and competent when interacting with this service user group. Furthermore, healthy workplace cultures and maintaining a safe environment are necessary for effective caring interactions with people hearing voices.

A systematic review of the outcomes of using voice hearing simulation in the education of health care professionals and those in training

OBJECTIVES

To identify and synthesise data from studies that have evaluated the outcomes of voice hearing simulation as an educational intervention with health care professionals and those in training.

DESIGN

The research employed a systematic review that was informed by Centre for Reviews and Dissemination DATA SOURCES: The databases Web of Science, Medline, Embase, PsycINFO, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials Register and CINAHL were systematically searched to January 2020.

REVIEW METHODS

Identified studies were screened by title (n = 509), abstract (n = 246) and full text (n = 56) using the following inclusion criteria: studies employing either qualitative and/or quantitative research methods, which have evaluated voice hearing simulation as a principal educational intervention with health care professionals during training or post-qualification.

RESULTS

Twenty six studies were included in the review. Eleven studies adopted mixed methods, five adopted quantitative methods and ten used qualitative methods. Although most of the studies were of low to medium quality the findings were encouraging and suggest that voice hearing simulation may be a useful educational intervention. Positive outcomes of simulation included improvements in empathy, attitudes, knowledge, understanding about voice hearing experiences and increased confidence in practice. The majority of participants that took part in voice hearing simulation thought that it was a powerful learning experience that should be offered to other health care professionals and those in training.

CONCLUSIONS

Voice hearing simulation is a valuable educational intervention that should be routinely used by academics when teaching health professionals and those in training about the experiences of people who hear voices. However, to confirm its true effects and optimum mode of delivery further better quality research is needed.

Face-to-Face and blended methods to improve oral competence in nursing students through simulation

Communication and interpersonal skills are relevant to the health professions, so it is important to promote these competencies at university. This research assesses the effectiveness of teaching oral competence through simulation using face-to-face and blended methods. A public speaking workshop was conducted in a group of 144 first year nursing students. Three groups were obtained according to the teaching method (Group 1: traditional method-3 sessions, Group 2: traditional method-2 sessions, Group 3: blended method-2 sessions). Public speaking confidence was measured at the beginning and end of the training, and oral competence was assessed at the end. As a result, all groups achieved a good level of oral competence after the training. However, while students in Group 1 showed greater oral competence, with regard to confidence in public speaking, students in Group 1 showed significantly worst results than those in Group 3. We concluded that simulation is a useful strategy to improve cognitive learning, and behavioural and practical competencies such as public speaking. As for the teaching method, although blended learning did not offer better results than traditional learning, it seems useful provide there is at least one face-to-face session so that the student can perform a speech and receive corrective feedback.

Practical reflections on a collaboration with healthcare consumers on the development of a simulation

Background

Healthcare simulations generate moments of ‘cultural compression’ through which we transmit core values about our professional identities and the families we care for. The engagement of healthcare consumers in this process is useful to evaluate the values we transmit and ensure authenticity in the narratives we share.

Methods

A simulation package on febrile neutropenia and port access was written by healthcare staff in consultation with the parent of a child with leukaemia. Healthcare consumer review was focused on the representation of the simulated parent within the simulation scripts. The child and his mother assisted in the development of supportive video resources on family perspectives on port access and demonstration of the procedure.

Results

The involvement of healthcare consumers in the development of the scenario had positive impact on the design and the supportive resources, both of which created opportunities for patient advocacy and reinforced the centrality of healthcare consumers within the healthcare team.

Conclusions

Healthcare consumer collaboration in scenario design was achievable and impactful without significant increased cost. We hope to promote the benefits of healthcare consumer consultation in simulation design to improve the pursuit of educational and cultural learning objectives.

Working with consumers who hear voices: The experience of early career nurses in mental health services in Australia

Mental health consumers who hear voices frequently experience distress and express a desire to discuss their voice-hearing experience. Nurses do not regularly demonstrate a willingness to engage in such discussions. With the introduction of educational strategies that develop empathy and an understanding of voice-hearing experiences, it is anticipated that early career nurses will be able to translate such understanding into their professional nursing practice. To explore early career nurses' understanding of providing care to mental health consumers who hear voices, a qualitative exploratory descriptive study was conducted in which nine early career Registered Nurses were interviewed regarding their experiences of caring for people who hear voices. Thematic analysis was employed to analyse the data and generate themes. Participants reported difficulty in developing relationships with consumers who hear voices, due to a workplace culture that was focussed on risk and lacking professional support. Nurses need specific education to develop the skills necessary to respond to consumers who hear voices and engage in dialogue that assists consumers to relate to the voices in a meaningful way. However, for this to succeed in practice, changes need to be supported by addressing the cultural barriers, such as risk-focussed environments, that prevent nurses implementing best practice.

Hearing Distressing Voices Simulation: Students' Perspectives

The aim of this qualitative study was to describe nursing students' experiences of hearing distressing voices through content analysis of essays regarding changes they encountered during simulation. Data, obtained from undergraduate (n = 237) and graduate (n = 128) students' short self-reflection papers, were analysed using a six-step thematic analysis. The following six themes emerged: (a) experiencing cognitive and perceptual challenges, (b) feeling unpleasant emotions, (c) dealing with functional changes and hardships, (d) experiencing somatic changes, (e) making attempts to cope, and (f) facing lingering impact. The findings suggest that students' experiences of voice-hearing simulation closely resembled the voice-hearers' actual experience. Simulation is an effective teaching modality to introduce nursing students to the world voice-hearers live in and to prepare them for clinical practice enlightened through understanding of what it is like to hear distressing voices.

Altered States of Consciousness: Evaluation of a voice-hearing simulation during an immersive art exhibition

AIM

To improve public understanding of the subjective experience of auditory hallucinations and increase empathy towards individuals who hear voices and have other unusual sensory experiences.

METHODS

This pilot study developed a new immersive art exhibition, Altered States of Consciousness, which gave members of the public an individualized voice-hearing simulation experience in 2 real-world settings-an art gallery and the London Underground. A total of 150 visitors completed visual analogue scales immediately before and after their experience of the exhibition.

RESULTS

Post-exhibition, there were significant increases in understanding what it feels like to hear voices, compassion towards voice hearers, and comfort in talking about these experiences. Participants enjoyed the simulation, felt they learned from their involvement, and did not find it stressful.

CONCLUSIONS

The exhibition and voice-hearing simulation has further potential for public engagement and stigma reduction.

Measuring the impact of a 'point of view' disability simulation on nursing students' empathy using the Comprehensive State Empathy Scale

BACKGROUND

Although empathy is an integral component of professional practice and person-centred care, a body of research has identified that vulnerable patients groups frequently experience healthcare that is less than optimal and often lacking in empathy.

AIM

The aim of this study was to examine the impact of an immersive point-of-view simulation on nursing students' empathy towards people with an Acquired Brain Injury.

SETTING AND PARTICIPANTS

A convenience sample of 390 nursing students from a cohort of 488 participated in the study, giving a response rate of 80%. Students undertook the simulation in pairs and were randomly allocated to the role of either a person with Acquired Brain Injury or a rehabilitation nurse. The simulated 'patients' wore a hemiparesis suit that replicated the experience of dysphasia, hemianopia and hemiparesis.

DESIGN

Characteristics of the sample were summarised using descriptive statistics. A two-group pre-test post-test design was used to investigate the impact of the simulation using the Comprehensive State Empathy Scale. t-Tests were performed to analyse changes in empathy pre post and between simulated 'patients' and 'rehabilitation nurses'.

RESULTS

On average, participants reported significantly higher mean empathy scores post simulation (3.75, SD=0.66) compared to pre simulation (3.38 SD=0.61); t (398)=10.33, p<0.001. However, this increase was higher for participants who assumed the role of a 'rehabilitation nurse' (mean=3.86, SD=0.62) than for those who took on the 'patient' role (mean=3.64, SD=0.68), p<0.001.

CONCLUSION

The results from this study attest to the potential of point-of-view simulations to positively impact nursing students' empathy towards people with a disability. Research with other vulnerable patient groups, student cohorts and in other contexts would be beneficial in taking this work forward.

Exploring learning content and knowledge transfer in baccalaureate nursing students using a hybrid mental health practice experience

BACKGROUND

Little research has been completed exploring knowledge development and transfer from and between simulated and clinical practice settings in nurse education.

OBJECTIVES

This study sought to explore the content learned, and the knowledge transferred, in a hybrid mental health clinical course consisting of simulated and clinical setting experiences.

DESIGN

A qualitative, interpretive descriptive study design.

SETTINGS

Clinical practice consisted of six 10-hour shifts in a clinical setting combined with six two-hour simulations.

PARTICIPANTS

12 baccalaureate nursing students enrolled in a compressed time frame program at a large, urban, Canadian university participated.

METHODS

Document analysis and a focus group were used to draw thematic representations of content and knowledge transfer between clinical environments (i.e., simulated and clinical settings) using the constant comparative data analysis technique.

RESULTS

Four major themes arose: (a) professional nursing behaviors; (b) understanding of the mental health nursing role; (c) confidence gained in interview skills; and, (d) unexpected learning.

CONCLUSIONS

Nurse educators should further explore the intermingling of simulation and clinical practice in terms of knowledge development and transfer with the goal of preparing students to function within the mental health nursing specialty.

Mental Health Education and Virtual Learning Environments (VLEs) in Pre-registration Nursing Degrees: Follow the Leaders?

Virtual learning environments (VLEs) are now commonly used, worldwide, as teaching and learning platforms for pre-registration nursing education. However, there is only limited evidence in the research literature to suggest that VLEs are employed to support the education of student nurses about mental health and illness. This article describes the work of mental health nurse educators who have taken the lead by providing case-based simulations on VLEs, thereby enabling students to acquire knowledge and develop the clinical skills required for practice in mental health settings. Benefits of VLEs include their flexibility and accessibility, and also the opportunity they provide for students to engage with Web 2.0 technologies. Leadership in education must include the utilization of the most current pedagogical tools and strategies, as well as staying abreast of contemporary evidence-based practices in clinical settings, to support the knowledge acquisition and practice-based learning of the registered nurses (RNs) of the future.