How psychiatric nursing students prepare to ask tough questions

May 13, 2019 | Health
Cindy Smith felt awful when she walked through the doors of the community mental health clinic. Everything was foggy. She was overwhelmed. She was exhausted. Life just didn’t seem worth living anymore.

Cindy was sitting in a small treatment room when Madelin Porayko knocked on the door, entered and sat across from her. The first-year Psychiatric Nursing Diploma student leaned in and quietly began asking her client a series of questions. What was happening in her life right now? What kinds of things was she finding difficult?

Then came the suicide risk assessment questions that are even harder to ask. Had Cindy thought about hurting herself or anyone else? Did she have a plan?

“It was nerve-wracking,” says Madelin, even though the scenario – and Cindy – weren’t real.

The small treatment room was actually in MacEwan University’s state-of-the-art clinical lab and simulation learning space in the Robbins Health Learning Centre, and “Cindy” was one of six standardized patients (actors playing a predefined role). Both were part of a simulation designed to help 72 psychiatric nursing students practice the skills they had been learning in their PNRS 155: Mental Health Nursing I course, and prepare for situations they might encounter in the clinical rotations set to begin just two days later.


Assistant Professor Ken Kustiak observes first-year psychiatric nursing student Madelin Porayko conducting a simulated suicide risk assessment.

“Suicide is a difficult topic and one many people are very uncomfortable talking about,” says Randi Ziorio Dunlop, assistant professor, Department of Psychiatric Nursing. “Giving students the chance to have their first conversation about suicide in a safe, controlled environment with a clear beginning and end allows them to practice challenging clinical situations before they experience them with a human being who is actually in pain. The chance to practice makes them feel more comfortable and allows them to relax and really be present and genuine.”

Either before or after they meet with “Cindy” themselves, students observe their classmates conducting an assessment via a live video feed. They also participate in a debriefing session where they reflect on how things went, what they might improve on in the future and the ways they can apply this experience to their clinical practice.“We learn these things in class, but it's so much more different when you have a real person sitting in front of you,” says Madelin. “It's a really cool way to apply what we’re learning – to figure out how to get the answers you need without pushing the person, and to practice feeling confident sitting in the silence. That’s something I’m still working on.”

Realizing that nobody’s perfect is also a valuable part of the debriefing process, says Madelin. “We’re all worried about how we’ve done, but we’re a small cohort and we support each other.”

This isn’t the first time the students, and their faculty members, have worked with “Cindy.” In the Fall semester, students practiced their therapeutic communication skills in a simulation with the same fictional client.

“Students are scaffolding their skills, and they can see how they’ve grown and changed,” says Randi. “It’s really neat to see them starting to feel empowered – they can see the abilities and skills they’re developing as new nurses, and as people.” 

Simulation in photos

MacEwan’s PAWSS dogs were there for the debriefing parts of the simulation. “Simulation can bring out a lot of anxiety, and the dogs help them release some of that,” says Randi. “In psychiatric nursing there are no x-rays or ultrasounds – we are the therapeutic tool, our relationships and the rapport we build can have a big impact on patient outcomes, so we need to know how to build healthy boundaries and take care of ourselves."
Randi Ziorio Dunlop and Ken Kustiak, assistant professors in the Department of Psychiatric Nursing, observe and discuss while six psychiatric nursing students conduct a suicide risk assessment simulation.

A Psychiatric Nursing Diploma student asks "Cindy" questions as part of a suicide risk assessment.
Observing other students in the simulation.
Students debrief after their experience.

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