The Effect of Simulation-Based Education Applied to Nursing Students on Approach to Individuals Diagnosed with Schizophrenia and Student Opinions: A Mixed Method Study

Abstract

Background: Due to the constraints faced in clinical settings, simulation-based applications have gained increasing significance in enhancing students’ knowledge and skills in nursing education.

Objectives: This study aims to evaluate the effectiveness of simulation-based training applied to nursing students to approach individuals diagnosed with schizophrenia.

Methods: The research was designed according to a concurrent triangulation design, a type of mixed methods research that collects and analyzes both quantitative and qualitative data simultaneously. The population of the research (n=68) consisted of senior nursing students in the fall semester of the 2023-2024 academic year. Quantitative data (n = 68) were collected using the Demographic Information Form and the Modified Simulation Effectiveness Tool, while qualitative data (n = 12) were collected through focus group interviews using a semi-structured interview form. Quantitative data were analyzed using SPSS 26.0. Qualitative data were analyzed through content analysis. 

Results: The total score of the students in the Simulation Effectiveness Tool- Modified was 75.20 ± 11.94, indicating that their perceptions of the effectiveness of simulation-based training in improving the students’ approach to individuals diagnosed with schizophrenia were positive. In the qualitative dimension, two themes and six subthemes of these themes were created. The themes were determined as Pre-Simulation Perspectives and Post-Simulation Development.

Conclusion: This study revealed that simulation-based training contributed positively to the knowledge, skills, and attitudes of nursing students in psychiatric diseases exposed to prejudices, such as schizophrenia. Future studies should examine the long-term effects of this training and evaluate its effectiveness in larger and more diverse student  samples.

 

Keywords

• Psychiatric Nursing
• Nursing Students
• Simulation-Based Education
• Schizophrenia
• Mixed Method

Hemşirelik Öğrencilerine Uygulanan Simülasyon Temelli Eğitimin Şizofreni Tanısı Almış Bireylere Yaklaşım ve Öğrenci Görüşlerine Etkisi: Karma Yöntem Çalışması

Abstract

Giriş: Klinik ortamlarda karşılaşılan kısıtlamalar nedeniyle, hemşirelik eğitiminde öğrencilerin bilgi ve becerilerini geliştirmede simülasyon tabanlı uygulamalar giderek önem kazanmaktadır.

Amaç: Bu çalışma, şizofreni tanısı konmuş bireylere yaklaşım konusunda hemşirelik öğrencilerine uygulanan simülasyon temelli eğitimin etkinliğini değerlendirmeyi amaçlamaktadır.

Yöntem: Araştırma, karma yöntem türlerinden, nicel ve nitel verilerin eş zamanlı olarak toplanıp analiz edildiği, eş zamanlı üçgenleme tasarımına göre tasarlanmıştır. 2023-2024 eğitim öğretim yılı güz dönemi son sınıf hemşirelik öğrencileri araştırmanın evrenini (n=68) oluşturmuştur. Nicel veriler (n=68), Tanıtıcı Bilgi Formu ve Modifiye Simülasyon Etkililik Aracı kullanılarak; nitel veriler (n=12) ise yarı yapılandırılmış görüşme formu kullanılarak odak grup görüşme yöntemi ile toplandı. Nicel verilerin analizi SPSS 26.0 kullanılarak yapılmıştır. Nitel verilerin analizi ise, içerik analizi yoluyla çözümlenmiştir.

Bulgular: Öğrencilerin Modifiye Simülasyon Etkililik Aracından aldıkları toplam puan 75.20 ± 11.94 olup, öğrencilerin şizofreni tanısı almış bireylere yaklaşımlarını geliştirmede simülasyon temelli eğitimin etkililiğine ilişkin algılarının olumlu olduğunu göstermektedir. Nitel boyutta iki tema ve bu temalara ait altı alt tema oluşturulmuştur. Temalar Simülasyon Öncesi Görüşler ve Simülasyon Sonrası Gelişim olarak belirlenmiştir.

Sonuç: Bu çalışma, simülasyona dayalı eğitimin şizofreni gibi önyargılara maruz kalan psikiyatrik hastalıklarda hemşirelik öğrencilerinin bilgi, beceri ve tutumlarına olumlu katkı sağladığını ortaya koymuştur. Gelecekteki araştırmalarda , bu eğitimin uzun vadeli etkileri incelenmeli ve daha geniş ve çeşitlilik arz eden öğrenci gruplarında etkinliği değerlendirilmelidir.

Keywords

• Psikiyatri Hemşireliği
• Hemşirelik Öğrencileri
• Simülasyona Dayalı Eğitim
• Şizofreni
• Karma Yöntem

References

1. Alexander, L., Coyte, B., Evans, A., Dickson, J., Guinea, S., & Foster, K. (2024). The educational value of mental health simulation in undergraduate Bachelor of Nursing education: An integrative review. Nurse Educ Today, 108, 105248.
2. Alhamidi, S. A., & Alyousef, S. M. (2023). Undergraduate nursing student mental health clinical experiences in Saudi Arabia: Findings from a qualitative study. J Am Psychiatr Nurses Assoc, 29(2), 136–145. https://doi.org/10.1177/10783903211000112
3. Arslan, E. (2025). Validity and Reliability in Qualitative Research. Pamukkale Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, (69), 383-394.
4. Avcil, C., Bulut, H., & Hızlı Sayar, G. (2016). Psikiyatrik Hastalıklar ve Damgalama [Psychiatric Disease and Stigmatization]. Üsküdar Üniversitesi Sosyal Bilimler Dergisi, 2(2), 175-202.
5. Bağrıaçık, E., Aydın, N., & Yılmaz, Ü. D. (2022). Hemşirelik eğitiminde simülasyon kullanımına ilişkin öğrenci görüşleri. J Educ Res Nurs, 8(2), 63–70. https://doi.org/10.55646/jaren.2022.43660
6. Başoğul, C. (2021). Views of Nursing Students Who Have Experienced Caring for Psychiatric Patients on Mental Illness and Stigma: A Phenomenological Study. Int Arch Nurs Health Care, 7, 158. https://doi.org/10.23937/2469-5823/1510158
7. Blake, T. (2019). Improving therapeutic communication in nursing through simulation exercise. Teach Learn Nurs, 14(4), 260–264. https://doi.org/10.1016/j.teln.2019.06.003
8. Chen, X., Wang, S., Liao, X., Li, Y., Leung, S. F., & Bressington, D. T. (2024). Interventions to decrease health students’ stigma toward schizophrenia: A scoping review. Int J Nurs Stud, 158, 104837. https://doi.org/10.1016/j.ijnurstu.2024.104837

9. Cheng, A., Auerbach, M., Calhoun, A., Mackinnon, R., Chang, T. P., Nadkarni, V., et al. (2018). Building a community of practice for researchers: the international network for simulation-based pediatric innovation, research and education. Simul Healthc, 13(3S), S28–S34.
10. Cheng, A., Eppich, W., Epps, C., Kolbe, M., Meguerdichian, M., & Grant, V. (2021). Embracing informed learner self-assessment during debriefing: The art of plus-delta. Adv Simul, 6(1), 22. https://doi.org/10.1186/s41077-021-00173-1
11. Choi, Y. J. (2012). Exploring experiences of psychiatric nursing simulations using standardized patients for undergraduate students. Asian Nurs Res, 6, 91–95. https://doi.org/10.1016/j.anr.2012.04.003
12. Colaizzi, P. F. (1978). Psychological research as the phenomenologist views it. In R. S. Valle & M. King (Eds.),
13. Existential-Phenomenological Alternatives for Psychology (pp. 6). Oxford University Press. Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed methods approaches (4th ed.). Sage.
14. Dawood, E., Alshutwi, S. S., Alshareif, S., & Shereda, H. A. (2024). Evaluation of the Effectiveness of Standardized Patient Simulation as a Teaching Method in Psychiatric and Mental Health Nursing. Nurs Rep, 14(2), 1424–1438. https://doi.org/10.3390/nursrep14020107
15. Donovan, L. M., & Mullen, L. K. (2019). Expanding nursing simulation programs with a standardized patient protocol on therapeutic communication. Nurse Educ Pract, 38, 126–131. https://doi.org/10.1016/j.nepr.2019.05.015
16. Doolen, J., Giddings, M., Johnson, M., Guizado de Nathan, G., & Badia, L. (2014). An evaluation of mental health simulation with standardized patients. Int J Nurs Educ Scholarsh, 11, 55–62. https://doi.org/10.1515/ijnes-2013-0075
17. Durmaz E. A., & Sarıkaya. (2015). A.The Use of Simulation in Nursing Education and Simulation Types. Hemşirelikte Eğitim ve Araştırma Dergisi. 12 (2): 121-125 ü. doi:10.5222/HEAD.2015.121.
18. Fernandes, J. B., Família, C., Castro, C., & Simões, A. (2022). Stigma towards people with mental illness among Portuguese nursing students. J Pers Med, 12(3), 326. https://doi.org/10.3390/jpm12030326
19. Gaba, D. M. (2007). The future vision of simulation in healthcare. Simul Healthc, 2(2), 126–135. https://doi.org/10.1097/01.SIH.0000258411.38212.32
20. Gandhi, S., Yeager, J., & Glaman, R. (2021). Implementation and evaluation of a pandemic simulation exercise among undergraduate public health and nursing students: A mixed-methods study. Nurse Education Today, 98, 104654. https://doi.org/https://doi.org/10.1016/j.nedt.2020.104654
21. García-Carpintero Blas, E., Vélez-Vélez, E., Gómez-Moreno, C., Martínez-Arce, A., Tovar-Reinoso, A., Rodriguez- Gómez, P., et al. (2024). Simulation with a standardized patient to reduce stigma towards people with schizophrenia spectrum disorder among nursing students: A quasi-experimental study. Arch Psychiatr Nurs, 52, 24–30. https://doi.org/10.1016/j.apnu.2024.07.015
22. Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ, 24(2), 105–112.
23. Happell, B., Waks, S., Bocking, J., Horgan, A., Manning, F., Greaney, S., et al. (2019). “I felt some prejudice in the back of my head”: Nursing students’ perspectives on learning about mental health from “Experts by Experience.” J Psychiatr Ment Health Nurs, 26(7–8), 233–243. https://doi.org/10.1111/jpm.12540
24. Hong, Q. N., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., et al. (2018). The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Educ Inf, 34, 285–291. https://doi.org/10.3233/EFI-180221
25. Karaduman, G. Ş., & Başak, T. (2022). Hemşirelik eğitiminde kullanılan simülasyon yöntemlerinin sınıflandırılması. DEUHFED, 15(1), 78–85. https://doi.org/10.46483/deuhfed.947218
26. Kirkbakk-Fjær, K., Andfossen, N. B., & Hedelin, B. (2015). Preceptors’ Expectations of Nursing Students’ Preparation before Placement in Psychiatry: Ability and Will to Reflect on and Exercise Knowledge. Issues Ment Health Nurs, 36(4), 300–306. https://doi.org/10.3109/01612840.2014.978424
27. Knutson de Presno, Å., Øgård-Repål, A., & Fossum, M. (2021). Simulations with Standardized Patients for Nursing Students in Preparation for Clinical Placements in Mental Health Care. Clin Simul Nurs, 54, 70–76. https://doi.org/10.1016/j.ecns.2021.01.009
28. Kulakaç, N., & Uzun, S. (2020). Psikiyatri hemşireliği dersi alan hemşirelik öğrencilerin şizofreniye yönelik tutumlarının çizme-yazma tekniği ile incelenmesi. Turkiye Klinikleri J Nurs Sci, 12(4), 596–606. https://doi.org/10.5336/nurses.2020-74781
29. MacLean, S., Geddes, F., Kelly, M., & Della, P. (2019). Video reflection in discharge communication skills training with simulated patients: A qualitative study of nursing students’ perceptions. Clinical Simulation in Nursing, 28, 15–24. https://doi.org/10.1016/j.ecns.2018.12.006
30. Mortan, O., Sütçü, T. S., & German, K. G. (2011). İşitsel halüsinasyonlarla başa çıkmaya yönelik bilişsel-davranışçı bir grup müdahalesinin etkililiği: Bir pilot çalışma. Turk Psikiyatri Derg, 22(1), 26–34.
31. Oh, S., & Park, J. (2023). A literature review of simulation-based nursing education in Korea. Nurs Rep, 13(1), 506–517. https://doi.org/10.3390/nursrep13010046
32. Øgård-Repål, A., De Presno, Å. K., & Fossum, M. (2018). Simulation with standardized patients to prepare undergraduate nursing students for mental health clinical practice: An integrative literature review. Nurse Educ Today, 66, 149–157. https://doi.org/10.1016/j.nedt.2018.04.018
33. O’Ferrall-González, C., Almenara-Barrios, J., García-Carretero, M. Á., Salazar-Couso, A., Almenara-Abellán, J. L., & Lagares-Franco, C. (2020). Factors associated with the evolution of attitudes towards mental illness in a cohort of nursing students. J Psychiatr Ment Health Nurs, 27(3), 237–245. https://doi.org/10.1111/jpm.12572
34. Olasoji, M., Garvey, L., Sadoughi, N., & Willetts, G. (2023). A qualitative study on undergraduate student nurses’ experience of mental health simulation preclinical placement. Clin Simul Nurs, 84, 101455. https://doi.org/10.1016/j.ecns.2023.101455
35. Onay, T., Gulpinar, M. A., Saracoglu, M., & Akdeniz, E. (2024). Determining the effectiveness of a virtual service/patient-based education program on patient care and clinical decision-making in nursing: A quasi-experimental study. North Clin Istanb, 11(5), 422–433. https://doi.org/10.14744/nci.2024.78095
36. Outlaw, K., & Rushing, D. S. (2018). Increasing empathy in mental health nursing using simulation and reflective journaling. J Nurs Educ, 57(12), 766. https://doi.org/10.3928/01484834-20181119-08
37. Røssland A, Svellingen A, Røykenes K. (2022). Role Exchange in Student-led Simulation: The Importance of Nursing Students Taking the Role of Patients. Sage Open Nursing. 8. doi:10.1177/23779608221130605
38. Roh, Y. S., Kelly, M., & Ha, E. H. (2016). Comparison of instructor-led versus peer-led debriefing in nursing students. Nurs Health Sci, 18(2), 238–245. https://doi.org/10.1111/nhs.12259
39. Speeney, N., Kameg, K. M., Cline, T., Szpak, J. L., & Bagwell, B. (2018). Impact of a standardized patient simulation on undergraduate nursing student knowledge and perceived competency of the care of a patient diagnosed with schizophrenia. Arch Psychiatr Nurs, 32(6), 845–849. https://doi.org/10.1016/j.apnu.2018.06.009
40. Wands, L. M., Pfeiffer, K. M., & Pelkmans, J. (2022). Demonstration of caring and motivational interviewing in online simulation: A cross-sectional observational study. Nurse Education in Practice, 63, 103370. https://doi.org/10.1016/j.nepr.2022.103370
41. Webster, K. E. F., & Carlson, E. (2020). Building therapeutic connections with the acutely ill through standardised patient simulation in nurse education: An evaluation study. Nurse Education Today, 84, 104261. https://doi.org/10.1016/j.nedt.2019.104261
42. Yıldırım, A., & Şimşek, H. (2021). Sosyal bilimlerde nitel araştırma yöntemleri (Güncelleştirilmiş, geliştirilmiş 12. baskı). Seçkin Yayıncılık.
43. Zare-Bidaki, M., Ehteshampour, A., Reisaliakbarighomi, M., Mazinani, R., Khodaie Ardakani, M. R., Mirabzadeh, A., et al. (2022). Evaluating the effects of experiencing virtual reality simulation of psychosis on mental illness stigma, empathy, and knowledge in medical students. Front Psychiatry, 13, 880331. https://doi.org/10.3389/fpsyt.2022.880331