Impact of Simulation-Based Intervention on Empathy, Communication, and Self-Efficacy Among Mental Health Nursing Students

Overview

This randomized controlled trial aims to evaluate the effectiveness of a standardized patient simulation-based educational intervention among undergraduate nursing students enrolled in the Mental Health Nursing course at the Department of Nursing, Faculty of Health Sciences, Cyprus International University, during the 2025-2026 academic year. A total of 70 eligible undergraduate nursing students were randomly allocated to an experimental group or a control group. Students in the experimental group participated in a structured simulation-based educational program using trained standardized patients portraying individuals with bipolar disorder. The simulation scenarios represent common clinical presentations of bipolar disorder, including acute manic episodes, depressive episodes , emotional instability, and mixed features associated with medication non-adherence. Students practice mental health assessment, therapeutic communication, therapeutic relationship building, and appropriate nursing interventions, followed by structured debriefing and reflection. The intervention was based on the principles of Jean Watson's Theory of Human Caring and was delivered through weekly simulation sessions. The control group received the routine Mental Health Nursing curriculum, including theoretical instruction and regular clinical placement experiences, without participation in the standardized patient simulation program. The primary outcome is therapeutic communication skills, while secondary outcomes include empathy and communication self-efficacy. Outcomes will be assessed using validated assessment scales at baseline and after completion of the intervention. The study evaluate whether standardized patient simulation is more effective than traditional teaching methods in developing key clinical and interpersonal competencies among undergraduate nursing students preparing to care for patients with bipolar disorder.

\### Detailed Description Mental health nursing education requires students to develop not only theoretical knowledge but also the interpersonal and clinical skills needed to establish therapeutic relationships and communicate effectively with individuals experiencing mental health conditions. Traditional teaching approaches may provide limited opportunities for students to practice these skills in realistic and controlled clinical situations. This study investigate whether standardized patient simulation can provide an effective educational approach for developing key competencies among undergraduate nursing students enrolled in a Mental Health Nursing course. The simulation-based intervention will use trained standardized patients to portray individuals with bipolar disorder in realistic clinical scenarios. The scenarios was design was taking from a textbook of mental health scenarios to reflect different clinical presentations and challenges that nursing students may encounter when caring for individuals with bipolar disorder. The educational approach incorporated principles derived from Jean Watson's Theory of Human Caring, with particular emphasis on the development of empathy, therapeutic communication, therapeutic relationships, and students' confidence in communicating with patients. Simulation activities provide students with opportunities to apply theoretical knowledge in practice, receive structured feedback, and reflect on their clinical performance through guided debriefing. The study used a randomized controlled design to compare the simulation-based educational approach with the routine Mental Health Nursing curriculum. The study examine whether participation in standardized patient simulation results in greater improvements in therapeutic communication, empathy, and communication self-efficacy compared with conventional educational approaches. The findings of this study may contribute to the evidence regarding the use of standardized patient simulation in undergraduate mental health nursing education and may help inform the development of educational strategies aimed at strengthening students' clinical and interpersonal competencies before and during their clinical practice.