Issues in Mental Health Nursing, 30:503–508, 2009
Copyright © Informa Healthcare USA, Inc.
ISSN: 0161-2840 print/ 1096-4673 online
DOI: 10.1080/01612840802601366
Communication and Human Patient Simulation in
Psychiatric Nursing
Kirstyn Kameg, DNP, CRNP, BC
Robert Morris University, Moon Township, Pennsylvania, USA
Ann M. Mitchell, PhD, RN, FAAN
University of Pittsburgh, Pittsburgh, Pennsylvania, USA
John Clochesy, PhD, RN, FAAN
Case Western Reserve University, Cleveland, Ohio, USA
Valerie M. Howard, EdD, RN
Robert Morris University, Moon Township, Pennsylvania, USA
Jane Suresky, ND, APRN, BC
Case Western Reserve University, Cleveland, Ohio, USA
Communication is an integral component of nursing educa-
tion and has been shown to improve health outcomes, patient
compliance, and patient satisfaction. Psychiatric nursing empha-
sizes knowledge and utilization of communication skills. Nursing
students often express anxiety and lack of confidence regarding
communicating with patients diagnosed with psychiatric illnesses.
Human patient simulation is one method that may be used for stu-
dents to practice and become proficient with communication skills
in a simulated environment. The authors of this article provide
an overview of communication and psychiatric nursing as well as
review of the current research related to the use of human patient
simulation in nursing education.
Communication is an integral component of nursing educa-
tion and has recently been a focus of attention both nationally
and internationally. Effective communication has been shown to
improve health outcomes, patient compliance, and patient sat-
isfaction (Stewart, 1995; Williams, Weinman, & Dale, 1998).
The Joint Commission on Accreditation of Healthcare Organi-
zations (JCAHO) reported that communication issues were the
root cause of approximately 65% of the 2,966 sentinel events
identified from 1995 to 2004 (JCAHO, 2005). Communication
failures are increasingly being implicated as factors influencing
patient safety (Chassin & Becher, 2002; Helmreich & Merritt,
1998; Institute of Medicine, 2000). Today medical care involves
Address correspondence to Kirstyn Kameg, Robert Morris Uni-
versity, School of Nursing, 6001 University Blvd., Moon Township,
15108. E-mail: kameg@rmu.edu
shorter hospital stays, increased patient acuity, and coordination
of care by numerous specialists. These complex changes affect
both nurses and nurse educators and have made it necessary
for nurse educators to ensure that nursing students possess the
knowledge and skills to effectively communicate with patients,
their families, and other members of the healthcare team.
Psychiatric nursing is an area of specialization within nursing
curricula that emphasizes knowledge and utilization of commu-
nication skills. Other nursing specialties provide students with
the opportunity to apply knowledge and psychomotor skills that
they have acquired in the didactic component of the class to
patients experiencing both acute and chronic medical problems
in the clinical setting. Because clients hospitalized in acute psy-
chiatric settings are generally medically stable, students are
provided with the opportunity to focus on utilizing commu-
nication skills to establish a therapeutic relationship; however,
there have been numerous studies indicating that students’ neg-
ative attitudes, fear, and anxiety can hinder both learning and
development of the therapeutic relationship (Bower, Webb, &
Stevens, 1994; Melrose & Shapiro, 1999; O’Brien, 1994; Tully,
2004).
Nurse educators also face the challenge of the changes that
have occurred in the mental health system including restruc-
tured provision of services, budget constraints, limited reim-
bursement, and higher patient acuity (Melrose, 2002). These
changes have led to reduced lengths of hospital stays that can
ultimately impede students’ learning in the psychiatric clini-
cal setting. This provides challenges for nurse educators who
need to identify innovative techniques to ensure that students
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