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Using Virtual Simulation to Support Mental Health Education

Shifting Perceptions

Identifying mental illness in a patient can be one of the biggest challenges that a nurse faces. The ability to recognize an underlying mental illness can drastically change the assessment and diagnosis processes, and therefore the treatment plan. The net result can translate into better patient outcomes.

One in four people – approximately 450 million people worldwide – suffer from mental disorders.1 Yet, up to 50% of serious cases go untreated in high-income countries.2 Misdiagnosis is common in the realm of mental health, often because symptoms can often materialize in different ways and at different times. Nurses can feel more confident in their ability to assess and diagnose a mentally-ill patient when they have an understanding of how certain mental illnesses present themselves, and the critical-thinking skills required to take an accurate patient history.

Recognition is the first step in providing the proper treatment. In this article, we discuss how training with a practical delivery mode, like virtual simulation, can better prepare nursing students to recognize mental illness and can promote a more favorable attitude by care givers toward patients with a mental illness. The result can be better patient-centered care.

A Mental Health Crisis?

In the United States, approximately 56 million American adults suffer from mental illness.3 Suicide is the tenth leading cause of death, and four of the ten leading causes of disability are mental disorders (major depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder).4,5 Some experts have even begun to label the growing concern over mental illness as a “mental health crisis”.

Nurses are the largest group of professionals providing mental health care, whether it’s in primary or specialist health services. Because of nurses’ direct relationships with patients, it is critical that they feel confident in their ability to detect mental illness and treat patients accordingly. Nursing educators advocate for an early and immersive mental health education at both the pre-licensure and graduate levels.7

“With the state of mental health in America, we desperately need a cadre of health professionals, and in particular nurses, who are able to identify, assess, and treat patients with mental health needs”

Bridgette M. Brawner, PhD, APRN, University of Pennsylvania School of Nursing *

Despite resounding agreement among nurse educators about the importance of mental health education, there is often a question of just how to impart the right skills to learners. Some facilities have introduced standardized patients, or actors who play the part of a patient suffering from a mental illness. Though this can be extremely useful in teaching how to take the patient’s history, educators commonly state that the inability of standardized patients to display physiological changes is a shortcoming. Other facilities have implemented the use of high-fidelity simulators in their nursing programs, which can demonstrate physiological changes throughout the care pathway and serve as a means to augment learner’s existing knowledge.

Virtual simulation, a method of engaging students via eLearning, has increased in popularity because it can help to introduce mental health education in an interactive and realistic way. In fact, 65% of nursing programs are currently using virtual simulation.8 Through the use of virtual simulation, learners can fine-tune their assessment skills and improve their ability to recognize mental illness, both through the observable physiological changes and the patient interview.

Attitudes: A Quality Check

Those affected by mental illness often avoid seeking help due to public stigma surrounding mental disorders. Culturally, we have still not advanced beyond socially shunning those who suffer from mental illnesses.9 The general public has made strides toward helping patients of mental illness, but there are still underlying stigmas that can negatively affect relationships. And, nurse-patient relationships are no exception.

Research has shown that stigmatizing attitudes are also found among healthcare staff and they are reflective of negative public opinion.10 This has raised concern about the quality of care that mental health patients are receiving. Assumptive and bias perspectives can negatively impact the care of a patient.

“The stigma is a huge problem to overcome. Imagine if you believed all patients were dangerous and could hurt you. You’d need to be constantly on the defensive. It would create problems in caring for them.”

Cynthia von Grauvogl, RN-BC, MSN, CARN-AP, California State University Fullerton School of Nursing **

Factors contributing to these negative perceptions are:11

  • Lack of knowledge
  • Less professional experience
  • No familiarity (i.e. no friends or relatives with mental illness)

Conversely, increased mental health education and more experience with mental illness can influence a healthcare provider’s attitude in a positive direction. Nurse educators are tasked with providing a mental health education that fosters inclusivity, empathy, and respect for patients suffering from mental illness.

“The most important thing a nursing program can do to prepare nurses to care for patients with mental illness is to teach them that mental health issues are widespread among the population and that someone with mental illness deserves the same care, compassion, and respect as any other patient,” says Mary Wickman, RN, PhD, University of Southern California in Costa Mesa.12 In addition, educators should be debunking myths – especially in regard to violence among the mentally ill. Only 3-5% of violent acts can be attributed to individuals living with a serious mental illness.13

Preparation for nursing students is awareness. By exposing learners to common behaviors and symptoms associated with mental illness, their perceptions of what a mentally ill patient “looks like” or “acts like” will gradually shift from stigma to reality. 

Simulation benefits learners in this regard because it provides an opportunity to introduce less common events that may not be seen in a traditional clinical placement.14 Virtual simulation, specifically, is proven to be a consistent and effective method of training nurses. Research has shown that up to 60% better consistency of learning can be achieved through technology-based training.15 Each scenario requires learners to gather the patient history and practice patient-centered care. The learning experience promotes the development of critical-thinking and decision-making skills, while also giving learners a “real life” experience with mental illness.

“When they have to ‘think on their feet’ to implement the skills they’ve learned in lectures, they are better prepared to handle complex clinical scenarios.”

Bridgette M. Brawner, PhD, APRN, University of Pennsylvania School of Nursing ***

Virtual Simulation Can Fill in the (Knowledge) Gaps

Simulation in mental health nursing can help to develop empathetic care practices and increase a student’s understanding of mental illness.16 Both of these developments can contribute to higher recognition, a reduced chance of misdiagnosis, and better quality of care.

With virtual simulation, which allows learners to move at their own pace, the benefits are manifold. One study found that when nursing staff engaged autonomously with interactive video learning, they had greater compliance and satisfaction with training compared to those who received only lecture.17 And, another study found that virtual patients help to teach clinical decision-making skills to nursing students.18 During a virtual simulation, there is no risk associated with incorrect diagnosis and treatment, which gives students the freedom to make mistakes before they treat their first real patient.

Virtual simulation can also help to locate and fill knowledge gaps left behind from textbook readings and lectures. Increasing students’ skills in therapeutic communication, critical thinking, problem-solving, decision-making, and risk assessment in mental health nursing practice, simulation provides the exposure students need.19

Equipped with the skills to recognize and empathetically treat patients, your nurses will feel competent and confident in their ability to address mental illness.

“Whether one intends to work in neonatal intensive care, or build community capacity in Guatemala, psychiatric-mental health assessment and intervention is essential to nursing practice regardless of where we work.”

Bridgette M. Brawner, PhD, APRN, University of Pennsylvania School of Nursing ****


  1. International Center for Clubhouse Development. (2018). Key facts about mental illness. Retrieved from
  2. Ibid
  3. American Psychiatric Nurses Association. (2018). Whole health begins with mental health. Retrieved from
  4. U.S. Department of Health & Human Services. (2017). Mental health myths and facts. Retrieved from
  5. Daller, J.A. (2017). Mental disorders in america. Retrieved from
  6. American Psychiatric Nurses Association. (2018). See Reference #3.
  7. Farmer, R. (2016). How nursing schools are addressing the mental health crisis. Daily Nurse. Retrieved from
  8. Wolters Kluwer. (n.d.) How nursing education programs are currently using educational technology. Retrieved from
  9. Sabella, D. & Fay-Hillier, T. (2013). Challenges in mental health nursing: Current opinion. Nursing: Research and Reviews, 2014(4), 1-6. DOI:
  10. Martensson, G., Jacobsson, J.W. & Engstrom, M. (2014). Mental health nursing staff’s attitudes toward mental illness: An analysis of related factors. Journal of Psychiatric and Mental Health Nursing, 21(9), 782-788. DOI: 10.1111/jpm.12145
  11. (2014). Treating the mind: Part I on mental illness. Retrieved from
  12. Ibid
  13. U.S. Department of Health & Human Services. (2017). See Reference #4.
  14. Alexander, L., Sheen, J., Rinehart, N., Hay, M., & Boyd, L. (2018). Mental health simulation with student nurses: A qualitative review. Clinical Simulation in Nursing, 14, 8-14. DOI: 10.1016/j.ecns.2017.09.003.
  15. Urdan, T.A. & Weggen, C.C. (2000). Corporate elearning: Exploring a new frontier. Berwyn, PA: WR Hambrecht & Co.
  16. Brown, A.M. (2015). Simulation in undergraduate mental health nursing education: A literature review. Clinical Simulation in Nursing, 11(10), 445-449. DOI:
  17. Rosen, J., Mulsant, B.H., Kollar, M., Kastango, K.B., Mazumdar, S., & Fox, D. (2002). Mental health training for nursing home staff using computer-based interactive video: A 6-month randomized trial. Journal of the American Medical Directors Association, 3(5), 291-6. Retrieved from
  18. Guise, V., Chambers, M., & Valimaki, M. (2011). What can virtual patient simulation offer mental health nursing education? Journal of Psychiatric and Mental Health Nursing. DOI:
  19. Brown, A.M. (2015). See Reference #16.


* Farmer, R. (2016). See Reference #7.

** (2014). See Reference #11.

*** Farmer, R. (2016). See Reference #7

****Farmer, R. (2016). See Reference #7.