"Making It Real": How live mental healthcare simulations encourage student empathy

Nursing students interact with a participant in the Making It Real simulation. Picture by Jack Schmidt

Nursing students interact with a participant in the Making It Real simulation. Picture by Jack Schmidt

In summary: 
  • A series of award-winning mental health care simulations is helping UTS nursing students develop the rapport and empathy they need to be effective in professional practice
  • The "Making It Real" simulation brings students together with people who have lived experience of mental illness
  • Today is World Mental Health Day and this week is National Mental Health Week

According to UTS Health academic Fiona Orr, empathy – the process of stepping into someone's shoes and attempting to connect and understand how they are thinking and feeling – is an "absolutely essential" component of working as an effective health care professional. 

Nurses in particular spend extended periods of time with healthcare consumers, so being able to show sensitivity and respect, build rapport and demonstrate empathy are vital skills which facilitate the development of trusting, collaborative partnerships between health care providers and consumers. 

But how can universities help students to develop their therapeutic communication skills?  In the UTS Faculty of Health, Orr, in collaboration with fellow UTS academics and healthcare consumers, has developed a series of award-winning mental health care simulations, including the "Making It Real" simulation, wherein nursing students get the opportunity to engage directly with people who have lived experience of mental illness.

Making It Real gives third-year UTS nursing students the opportunity to practise newly learnt recovery-focused, therapeutic communication skills in a safe, simulated environment. 

At the start of the class, students are introduced to a group of four to five invited guests with lived experience of mental ill-health. The students are then placed in pairs, and throughout the two-hour session, these pairs get an opportunity to interact with one of the consumers. 

Students and visitors freely converse and build a dialogue about the consumer's healthcare experiences and recovery process. Following their 15-18 minute interaction, students receive immediate feedback from the consumers about what worked well and what could be developed further.

The student pairs then reflect on the skills developed during the experience, guided by a self-reflection template, and at the end of the session, the entire class reforms to process and discuss the experience with fellow students, the lecturer (Fiona Orr) and the participating consumers.

Students have relished the opportunities to put their theoretical studies into practice and feedback from this year's participating students has been overwhelmingly positive.

"It's great to get an opportunity to engage beyond the clinical level," said one student. "To just converse with consumers and share your personality is a really important part of your care as a mental health nurse."

"I think it's the best way to see the healthcare experience through the consumer's eyes," said another. "I've never learnt so much in fifteen minutes! These sorts of engagements help to humanise the consumer-nurse relationship.  In reality, it's just two people sitting down for a person-to-person conversation, building trust and empathy."

The participating consumers were equally enthusiastic about the experience, praising the nurses-to-be on their sensitivity, understanding and professional competencies.

"I really appreciated people sitting down for a conversation and 'making it real' by sharing snippets of their own lives," said participating guest Irene Gallagher. "Openness builds trust, which is so important in mental healthcare.  If nurses or student nurses are willing to share snippets of their lives, then we're more willing to share information about our lives.  I love these experiences – they give me an incredible amount of hope for the future."

"I find it a humbling experience," said fellow guest Tim Heffernan. "These opportunities to make human connections in a safe space are invaluable for all of us as co-workers and as human beings."

For lecturer and subject coordinator Fiona Orr, facilitating these live simulations over the past three years has been a hugely rewarding experience. 

"I love seeing the animation in the students' faces as they talk with the consumers. Some students are a bit nervous or anxious before sitting down for a conversation, so it's great to see them then engage with the person and learn from their experience."

Orr, who has extensive experience as a registered mental health nurse and a nursing educator, is also a driving force behind the development of a "Hearing Voices" simulation, in which students are encouraged to carry out everyday activities in the classroom and around the campus while listening to MP3s of simulated sounds and voices produced by people with a lived experience of voice-hearing.  

Orr's PhD research on the value of the simulation has found that it increases student empathy and understanding of the experience of voice hearing and builds confidence in providing appropriate care.

"Good nurses look beyond the diagnosis or the illness and see the person and their strengths – they see their positive attributes and work alongside consumers as they determine the life they will lead," said Orr.

"I think it's a privilege to be with people, to listen to their story and to support and assist them in whichever ways you can. When someone experiences a mental illness they can feel very vulnerable, so it's really important that nurses are trustworthy, compassionate and interested in supporting the person."