Document Type

Report

Publication Date

Spring 2023

Date of Final Presentation

3-30-2023

Committee Chair

Teresa Serratt, PhD, RN

Committee Member

Kelley Connor, PhD, RN, CHSE

Coordinator/ Chair of DNP Program

Teresa Serratt, PhD, RN

Abstract/ Executive Summary

Problem Description

Pediatric mental and behavioral health care needs continue to increase across the nation. Approximately ten percent of pediatric hospitalizations are for a primary mental or behavioral health condition (Canvara & Johnson, 2020). With the increase in hospitalizations for mental health (MH) needs, pediatric psychiatric units are at capacity, and MH patients are admitted to pediatric general medical/surgical units for care. Most of the nurses that work on these units have not received pediatric mental health education outside of nursing school curricula and report a lack of confidence in their ability to care for pediatric MH patients. With the pediatric MH population growing, meeting the needs of these patients with nursing care is essential.

Setting

This DNP project was conducted at a large pediatric health system in the Pacific Northwest with over 2,000 nurses. This project was implemented on a 32-bed pediatric medical unit that employs approximately 82 nurses. Children experiencing primary mental health diagnoses in this unit include major depressive episodes, autism spectrum disorder, suicidal ideation, and eating disorders.

Rationale

Evidence suggests that one way to improve the MH care patients receive is through education. Kolb’s Experiential Learning Theory (ELT) provided a theoretical framework to develop a course that incorporated didactic content with a concrete learning experience. Standardized Patient (SP) simulation was used and is a modality that aligns with Kolb’s ELT. It allows a nurse to practice concepts in a realistic scenario while getting feedback directly from a patient (actor) on how the nurse’s actions impacted the patient and their behavior. Mental Health SP simulations improve both knowledge and self-efficacy in nurses significantly.

Project Aims

This DNP project sought to identify and implement an educational program that included SP simulation to improve nurses’ confidence in caring for pediatric MH patients in a pediatric inpatient medical unit.

Project Outcomes

Five short-term outcomes (STOs) measured the success of this DNP pilot project. Project outcomes included course participation goals, nurse confidence (self-efficacy) improvement, nurse knowledge improvement, decreased behavioral resource support requests, and improved epic care plan documentation data.

Implementation and Evaluation Plan

Project implementation consisted of facilitator/Standardized Patient (SP) training with six planned classes over eight weeks. Nurses self-enrolled in the course and completed a pre-knowledge and pre-self-efficacy assessment. During the scheduled course time, nurses went through a curriculum that consisted of one and a half hours of trauma-informed care and crisis management content followed by two hours of standardized patient simulation. Post-knowledge assessments and self-efficacy assessments were completed within two weeks post-course.

Results

Twenty-two percent (n=20) of eligible pediatric medical nurses participated in the pilot study. Overall, nursing self-reported confidence increased by 25%, and nursing knowledge increased by 4% post-education and SP simulation. Additionally, calls for direct nurse knowledge and coaching support to the behavioral response team decreased by 8%. Unfortunately, due to contextual factors, nursing care plan documentation was not assessed. However, one unexpected outcome was an improvement in patient belonging and safety screening by 13%.

Interpretation

The findings in this study align with the literature suggesting that mental health care education, specifically SP simulations, increases the knowledge and self-efficacy required of nurses to care for pediatric MH patients. This is likely due to incorporating experiential learning as a framework for educational design. Potential limitations to the results reported include a lack of pre- and post-requirement sample size (n=16) and the use of primary data tools the project manager developed. Despite the limitations, this pilot project suggests that an educational program including SP simulation aligns with the evidence and improves participant knowledge and confidence. The use of the Pediatric Mental Health Standardized Patient Simulation Course will expand to a nurse residency program in the next year.

Conclusion

Implementing a Pediatric Mental Health Standardized Patient Simulation Course improved non-mental health nurse self-efficacy in caring for mental health patients on the medical unit. This was validated not only through quantitative descriptive data but also qualitative feedback from the nurse participants. As caring for mental health patients becomes a norm for nursing in all units/divisions of nursing, investing in a learning environment where nurses can safely practice these challenging skills is important to ensure nurses feel prepared.

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