Abstract
Qualitative research indicates patients with comorbid physical and mental illnesses present unique circumstances for healthcare professionals (Giandinoto & Edward, 2015). The 2001-2003 National Comorbidity Survey Replication (NCS-R) estimates 29% of adults with a medical disorder have a comorbid mental health condition (as cited in Druss & Walker, 2011). Challenges in patient care include clients whose mental health illness is manifested by noncompliant, disruptive or unpredictable behavior; acute care settings without the environmental safety features of a psychiatric facility; and healthcare workers with limited knowledge of mental health pharmacology and behavior management (Giandinoto & Edward, 2015). Undergraduate and new graduate nurses must be prepared to function in a multidisciplinary system and offer patients safe, effective, patient-centered, and equitable care as outlined in Crossing the Quality Chasm: A New Health System for the 21st Century (Institute of Medicine [IOM], 2001). Synthesis and integration of behavioral and physiological health concepts are needed to ensure the delivery of appropriate care to all patients (Kameg, Englert, Howard, & Perozzi, 2013). Existing silos in undergraduate nursing education with limited integration of psychiatric and medical-surgical nursing contribute to learners’ inability to deliver effective care to patients with comorbid physical and mental illnesses (Kameg et al., 2013). One approach to integrate behavioral and physiological nursing education is the use of high fidelity patient simulation (HFPS) (Kameg et al., 2013; Levine, DeMaria, Schwartz, & Sim, 2014). Simulated clinical scenarios allow nursing students experience with patient care situations they might not have the opportunity to encounter in the clinical setting. Undergraduates in both medical-surgical and psychiatric nursing courses can benefit from simulation education (Levine et al., 2014). Benefits of simulation include a learning environment that poses no risk to an actual patient, repeated practice of skills with opportunities for constructive feedback, and the ability for educators to create scenarios that might be difficult to obtain equitably in student clinical placements including sensitive mental health clinician-patient conversations (Kameg et al., 2013; Levine et al., 2014). A pilot study was completed in a HFPS pedagogy to integrate concepts of mental health and medical-surgical nursing constructs in the undergraduate nursing curriculum. An unfolding case study utilized a standardized patient in two scenarios. Comorbidities of post-traumatic stress disorder (PTSD) and liver cirrhosis, and interpersonal communication dynamics were addressed. The primary investigators’ main research question was: Will high fidelity simulation scenarios integrating mental health and medical-surgical concepts be effective as an adjunct pedagogy and allow second-semester Bachelor of Science in Nursing (BSN) students to apply critical thinking constructs to patients with mental health and medical-surgical comorbidities.