Running head: article critique 1

Article Critique: Six Second Simulation

Shannon McNulty

William Paterson University

NURS 6021-803

Dr. Marshall

April 9, 2023
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Article Critique: Six Second Simulation

Auditory and visual hallucinations can impact judgement and decision-making abilities.

It is estimated that about one in twenty-five Americans lives with a serious mental illness and

more than 50% of Americans will be diagnosed with mental illness during the lifetime (CDC,

2021). The study conducted by Marshall et al., Fostering Transformation by Hearing Voices:

Evaluating a 6-Second, Low-Fidelity Simulation, explores the stigma of psychosis and the role of

auditory and visual hallucinations impact on nursing care. Increasing awareness and knowledge

about a patient’s perspective during auditory hallucinations can increase empathy and therapeutic

communication between patients and nurses (Marshall et al., 2018). This can promote the

nursing care of individual patients by focusing on comprehensive care – physically, mentally, and

socially.

Evaluation

The Topic

Marshall et al. (2018) discusses the stigma associated with auditory and visual

hallucinations and the nursing communication essential to the patient care. The research

implemented simulation in a classroom environment to develop skills, understanding, and

knowledge about the topic. It is imperative that nursing students have the fundamental ability to

understand patients with mental illness to ensure effective nursing care. Misconceptions

regarding mental illness can interfere with providing enhanced nursing care and simulations

serve as real-life experiences and roles that can improve efficacy (Marshall et al., 2018).

Increasing student perspectives about the challenges related to mental illness can improve

empathy and therapeutic communication.

Statement of the Problem

The problem discussed in the research by Marshall et al. (2018) focused on the lack of

understanding and stigma related to mental illness. Furthermore, this directly impacts the number

of nurse practitioners (NPs) who choose to pursue psychiatric nursing. It is estimated that about

3% of NPs choose to work in psychiatric nursing (American Association of Nurse Practitioners,

2012 as cited in Marshall et al., 2018). Despite the small percentage of NPs working in

psychiatric nursing, all nurses must have the ability to form a therapeutic alliance with patients.

Individuals with mental illness also require medical attention, such as routine appointments,

tests, and treatments. Therefore, it is essential that all nurses have the ability to effectively and

appropriately communicate with patients through empathy and therapeutic communication. It is

suggested that the prevalence of mental illness in the United States in 20% among adults

(Marshall et al., 2018). Furthermore, nurses will continue to encounter individuals who have co-

occurring mental disorders. A lack of understanding or knowledge regarding mental health can

negatively impact treatment and overall nursing care and result in poor health outcomes or death.

Research Question

The research question for this research project was the following: “Can a 6-second, low-

fidelity simulation increase empathy for patients experiencing auditory hallucinations?”

(Marshall et al., 2018). The research question focuses on the effect of the six-second simulation

on empathy for patients who are experiencing auditory hallucinations. It is expected that the

experience will positively influence knowledge and behavior for the students and promote

therapeutic communication when caring for individuals with mental illness. It is difficult to

understand various points of view. However, the research enhances wellness, therapeutic

communication, and overall improved health outcomes.

Literature Review
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There was no theory as theoretical framework for the research. However, it did include

many different pieces of evidence from various different articles and sources that focused on

empathy and therapeutic communication. The literature focused on the lack of NPs specializing

in mental health. There has been a poor correlation between nursing education and empathy.

Therefore, it is expected that an increase in simulation and real-life scenarios can promote

therapeutic communication between nurses and patients. In psychiatric nursing, there are three

methods of simulation – virtual environments, role-play, and mannequins (Brown, 2018 as cited

in Marshall et al., 2018). Simulation allows students to make real-time decisions in high-risk

scenarios (Marshall et al., 2018). It also provides students with healthcare skills in a safe learning

environment.

All nurses will interact with patients who have mental health disorders. Media has

developed biases for students, which can drastically impact the nursing care provided to patients.

There is a stress on the need for nurses to have the tools and knowledge to engage with patients

who have mental illness. The increased number of individuals who have mental health disorders

has increased as there are more treatment options. The literature describes the importance of

therapeutic communication between nurses and patients through real-life scenarios and

interactions.

The literature review serves as a background for the study and provides a significant

amount of evidence that supports the necessity of the research. There are important facts

provided and substantive evidence related to simulations and therapeutic communication.

Method

The study completed by Marshall et al. (2018) was conducted between 2010 and 2013 at

William Paterson University, which is located in the Eastern United States. It focused on junior-
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level students in a Baccalaureate Nursing Program. Participation in the study was voluntary and

the teaching institution granted the approval for the research. The participants submitted

reflections after the simulation and described the experience, set up, and any change in thinking

or practice (Marshall et al., 2018). The qualitative content was analyzed after a 6-second

simulation of an auditory hallucination using qualitative software, ATLAS.ti 7.

The researchers consisted of two certified psychiatric nurse practitioners who conducted

the simulation. The simulation included five participants each setup – the instructor, the student,

and three volunteers. While the instructor converses with the student, the three volunteers said a

unique phrase to the student. They acted as voices, or auditory hallucinations. If the student was

uncomfortable or appeared in distress at any point, the simulation was completed. After six

seconds, all simulations were completed.

The method that was used for the research study was the best for the study because it was

a qualitative, descriptive design. Considering the purpose of the study is to increase knowledge

and empathy for the patient with mental illness, it is important that the participant can give

qualitative feedback. In addition, it was important for the researcher to observe the student’s

facial expressions and body behavior during the simulation. However, it would be effective to

measure the change in knowledge or empathy despite the challenge. It is important to note that

the healthcare system is consistently evolving. The feedback from students may include bias,

which is important to consider when reviewing the data.

Results and Conclusions

A total of 212 reflections were collected from the research and 85 reflections were chosen

for review (Marshall et al., 2018). Atlas.ti 7 was used to code words, phrases, and sentences for

themes. The results showed 87% reliability (Marshall et al., 2018). Some themes that were
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identified in the research included empathy, knowledge, insight, therapeutic communication, and

value (Marshall et al., 2018). Most students in the study discussed feeling increased empathy for

individuals who suffer from auditory hallucinations and all students reported increased

knowledge and insight about psychosis, stress, and auditory and visual hallucinations (Marshall

et al., 2018). The narratives were highly suggestive of increased knowledge, reflective insight,

therapeutic communication, and empathy. This information has provided support for the research

because students had increased awareness of auditory hallucinations and individuals with mental

illness.

There was increased empathy, knowledge, and insight for students who participated in the

research study. Media and personal experiences caused bias for students before the research was

conducted. However, participation in the study resulted in respect and empathy for individuals

with mental illness. The simulation is cost-effective and can improve empathy and knowledge

for nursing students.

My Opinion

Overall, I believe the research that was conducted was very effective in providing a

simulation about auditory hallucinations for nursing students. It allowed students to be subject to

the overbearing nature of auditory hallucinations. Therefore, the student is given the

understanding about mental illness and how confusing it can be for individuals.
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References

American Association of Nurse Practitioners. (2012, November 1). National NP Week.

Retrieved from www.aanp.org/images/documents/press-room/npweek2012.pdf

Centers for Disease Control and Prevention. (2021). About mental health. Retrieved from

https://www.cdc.gov/mentalhealth/learn/index.htm

Marshall, B., Bliss, J., Evans, B., & Dukhan, O. (2018). Fostering Transformation by Hearing

Voices: Evaluating a 6-Second, Low-Fidelity Simulation. Journal of the American

Psychiatric Nurses Association, 24(5), 426–432.

https://doi.org/10.1177/1078390317750749