Simulation-Based Schizophrenia Training in Nursing Education

Overview

This study aims to examine the effect of a schizophrenia scenario-based simulation on nursing students' knowledge, empathy, and caregiving competence. The study uses a single-group pre-test/post-test (quasi-experimental) design. Nursing students enrolled in a Mental Health and Psychiatric Nursing course at a foundation university in Istanbul, Türkiye, who have not previously participated in a similar simulation, are invited to take part. Before the simulation, participants complete a set of questionnaires assessing their knowledge about schizophrenia, empathy level, and caregiving competence. They then take part in a structured simulation session involving a standardized patient portraying a person with schizophrenia. The session includes a preparation phase, a prebriefing session, a 15-minute clinical encounter in which the student conducts a therapeutic interview and mental status examination, and a debriefing session guided by a structured reflective model. Immediately afterward, participants complete the same questionnaires again, along with a scale measuring their perception of the simulation's educational effectiveness. The purpose of the study is to determine whether this type of simulation-based training improves nursing students' knowledge, empathy, and confidence in caring for individuals with schizophrenia, and to contribute evidence on the use of simulation in psychiatric nursing education.

Design: This study was conducted using a single-group pre-test/post-test quasi-experimental design to evaluate the integrated effect of a schizophrenia scenario-based simulation on nursing students' knowledge, empathy, and caregiving competence levels. Hypotheses: H1: Post-test mean knowledge scores of nursing students who participate in the schizophrenia scenario-based simulation will be higher than their pre-test mean scores. H2: Post-test mean empathy scores of nursing students who participate in the simulation will be higher than their pre-test mean scores. H3: Post-test mean caregiving competence scores of nursing students who participate in the simulation will be higher than their pre-test mean scores. Population and Sample: The study population consists of students enrolled in the Mental Health and Psychiatric Nursing course at the Nursing Department of a foundation university in Istanbul, Türkiye, during the 2025-2026 academic year (N= 120). The sample consists of students who had not previously participated in a similar schizophrenia scenario-based simulation and who agreed to participate in the study. Data Collection Tools: A Personal Information Form (developed by the researchers, covering age, gender, GPA, prior coursework/clinical experience in psychiatric nursing, prior contact with individuals diagnosed with schizophrenia, family history of psychiatric illness, and prior simulation participation), the Knowledge About Schizophrenia Questionnaire, the Toronto Empathy Questionnaire, the Caregiving Competence Scale, and the Simulation Effectiveness Tool-Modified (SET-M) were used. Simulation Intervention: The intervention was delivered before students began their psychiatric clinical placement and consisted of four sequential phases - preparation, prebriefing, clinical simulation, and debriefing - with identical learning objectives, environment, scenario, and procedures maintained across all participants to preserve intervention fidelity. Preparation Phase: Students attended theoretical coursework on therapeutic communication, the psychiatric nursing process, ethical/legal issues, psychoeducation, mental status examination, and nursing care for schizophrenia. The simulation scenario was developed by the research team, reviewed by three experts in psychiatric nursing and clinical simulation, revised accordingly, and pilot-tested with senior nursing students. Standardized patients (SPs) were trained by a researcher with over 10 years of experience in psychiatric nursing and simulation, following ASPE Standards of Best Practice, including an 8-hour training day and rehearsal sessions to ensure consistent role portrayal. Prebriefing Phase: Conducted immediately before the simulation (\~30 minutes) by the principal researcher, introducing the learning objectives, scenario, roles, process, and data collection forms, and establishing a psychologically safe learning environment. Pre-test questionnaires were completed at the end of this phase. Clinical Simulation Phase: Conducted individually in a simulation center designed to resemble an inpatient psychiatric ward. Each student engaged in an approximately 15-minute encounter with a standardized patient portraying schizophrenia, during which the student conducted a therapeutic interview and comprehensive mental status examination. Facilitators observed sessions through one-way mirrors using a structured checklist to ensure consistency. Debriefing Phase: A 60-minute session guided by the PEARLS (Promoting Excellence and Reflective Learning in Simulation) blended debriefing model, structured into reaction, analysis, and summary phases. Post-test questionnaires, including the SET-M, were completed immediately afterward. Data Analysis Plan: Data are analyzed using SPSS 22.0. Normality is assessed via skewness-kurtosis values. Descriptive statistics are used alongside the paired-samples t-test to compare pre-test and post-test measurements, with statistical significance evaluated at the 95% confidence level (p\<0.05)