ABSTRACT
Background Significance: A shortage of clinical sites has made it difficult for the psychiatric technician (PT) to practice skills, such as therapeutic communication. Therapeutic communication is an important component of the PT curriculum. The development of virtual reality (VR) software has the potential to enhance communication skills, addressing students' self-efficacy when communicating with patients suffering from mental illness. Problem: A lack of available clinical sites and COVID-19 has made it challenging for students to obtain hands-on performance skills, including their ability to develop the skill of therapeutic communication, and complete their training and certification. PT students are required to develop skills to assess the status of a patient's mental state and appropriately interact with their clients. Traditionally, this has been accomplished via on-site clinical experiences at health care sites. Methods: This was a feasibility and acceptability project using post-implementation surveys. The Simulation Evaluation Tool-Modified (SET-M) evaluates how well simulation met student learning outcomes, communication skills, and self-perception on ability to communicate. The System Usability Scale (SUS) evaluates the usability of the VR simulation technology. Interventions: A VR scenario featuring a patient with post-traumatic stress disorder (PTSD) was designed, and developed. The platform allowed the student to make critical decisions through the given scenario. Development of the scenario was guided by the "INACSL Standards of Best Practice" of the International Nursing Association for Clinical Simulation and Learning (INACSL) and the "Clinical Practice Guidelines for the Management of PTSD and Acute Stress Disorder" of the Department of Defense (DoD) and U.S. Veterans Affairs (VA). Content for the scenario was approved by content experts for validity. Training on the use of the VR platform was provided for faculty and PT students prior to completing the VR scenario. Evaluation: Data were analyzed to determine if the project aims were achieved. The aims of this project were to: (a) develop a 3D immersive clinical decision scenario using VR platform;(b) assess acceptance of the new technology;and (c) measure communication skills in a 3D VR environment. Results: The results of this project suggested that most students (84%) agreed that the VR software was easy to use. Ninety-six percent of students felt more confident in clinical decision and communication skills with the PTSD patient. The implementation of the VR was feasible and acceptable to students. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
Over 46 million adults in the United States (U.S.) live with a mental illness. Locally in Nevada, the psychiatrist to patient ratio is approximately 700:1, and patients are seen primarily in the inpatient setting, if seen at all, due to the wait average of 85 hours in the hospital emergency rooms for access into mental health hospitals or specialty units of a general hospital. Moreover, costs for mental health mood disorders alone are estimated at over seven million dollars annually. The Institute of Medicine (IOM) opined the need for change in healthcare to redesign practice and clinical communication with patients in all healthcare settings;however, more is still needed in mental health. Therapeutic communication is essential to meet the patient's physical and psychological needs while establishing the nurse-patient trusting relationship. Clinical outcomes in mental health settings remain poor, with non-therapeutic communication resulting in poor patient outcomes. A leading cause of inadequate treatment includes non-therapeutic communication during pre- and post-discharge treatment. It is not well described in the literature what role nurses play, nationally or locally, in ensuring the safe transition of mental health patients from an emergency room to a specialty unit. Mental health nurses are expected to complete clinical assessments on admitted clients, including effective therapeutic interpersonal communication techniques and psychosocial intervention skills to provide safety, trust, collaboration with rapport, respect, genuineness with the caring emphasis, and empathy. Nurses may be able to decrease adverse events within mental health settings, in part, by practicing therapeutic communication;unfortunately, evidence shows that nurses are often unprepared in mental health to incorporate therapeutic communication and relationship building among their patients. Expected knowledge of, and competence in therapeutic communication would seem to be a logical requirement for mental health nurses;however, Nevada's current practice does not require demonstrated knowledge and competency in therapeutic communication between mental health nurses and patients in hospital settings. Competency development may guide nurses to develop critical thinking skills to practice and support psychiatric patients to achieve optimal outcomes. The lack of required knowledge and competency related to therapeutic communication is the underlying impetus for this Doctor of Nursing Practice (DNP) project. The purpose of this DNP project was to develop, implement, and evaluate an educational module for mental health nurses and staff to improve knowledge and competency in therapeutic communication with their patients. The TeamSTEPPS Program was adapted to develop a mental health-specific educational module focused on therapeutic communication to accomplish this purpose. The educational module was implemented online due to Covid-19 Pandemic, and this intervention was evaluated using four previously validated TeamSTEPPS instruments. Fifty-two participants were included in this project. Results indicated a statistically significant change in knowledge and competency pre- compared to the post-intervention with the educational module. Based on the results of this project, one may conclude that implementing additional mental health education for nurses may improve their knowledge and competency related to therapeutic communications with their patients, as was demonstrated in this project. (PsycInfo Database Record (c) 2022 APA, all rights reserved)