Meeting Lucy Grey: A Suicidal Standardized Patient Experience for Senior Nursing Students

The mental health crisis in the United States will continue to rely on a nursing workforce that is prepared to meet that need head on. Simulation, as an evidence-based, technology-driven educational strategy, will continue to be a means of giving students a safe space to explore complex clinical phenomena. Experts like Dr. Laura Klenke-Borgmann and Regina Johnson, in their roles as faculty at The University of Kansas School of Nursing, continue to push the boundaries of innovation in teaching. They are helping to ensure that we not only optimally integrate the right technologies in the right ways but also ensure our vigilance as a profession to the health care needs of our times. Mathew D. Byrne, PhD, RN, CNE, Editor, Emerging Technologies Center Major depressive disorder is a complex disorder caused by a combination of factors. It impacts all aspects of our lives, including how we think, feel, and handle daily activities. Depression is a risk factor for dying by suicide. Suicide is the 12th leading cause of death in the United States and is considered a significant public health problem. In 2020, approximately 3.2 million people planned a suicide, 1.2 million attempted suicide, and more than 45,000 deaths occurred by suicide (United Health Foundation, 2023). One major goal of Healthy People 2030 (US Department of Health and Human Services, 2020) is to increase the proportion of adults with depression who receive effective screening and treatment. To meet this societal need, it was important at our university to provide our senior-level nursing students with a two-hour standardized patient (SP) experience of an outpatient suicidal patient. The specific objectives of the simulated experience were to: 1) prioritize patient assessment data and assess further when needed; 2) initiate appropriate safety measures, including the PHQ-9 screening tool and the Columbia Suicide Severity Scale; 3) adapt therapeutic communication techniques to support priority needs of the client; and 4) demonstrate compassionate, nonjudgmental, patient-centered care. The case adhered to the Healthcare Simulation Standards of Best Practice (INACSL Standards Committee, 2021). Lucy Grey was a 74-year-old female (played by a real actress) brought to an ambulatory care clinic after a fall at home. She stated she has been seen over the past few months in the emergency department for repetitive falls. She is a retired schoolteacher who lives alone. Her partner, Julia, died three months ago. Lucy is depressed and emotional and has a flat affect. She verbalized having suicidal thoughts but does not have a plan. (Both Lucy Grey and Julia Morales are the subjects of unfolding cases in the National League for Nursing’s ACE.S and ACE+ series, https://www.nln.org/education/teaching-resources/advancing-care-excellence.) For the first 30 minutes, the simulation faculty conducted a prebriefing for the learners. This included establishing a safe container and brief content delivery related to depression, suicidal ideation, and the PHQ-9 and Columbia Suicide Severity Scale needed for the simulation. Then, two students actively participated in the 15-minute SP scenario described above. The other six students in the group observed while completing an observer worksheet. Once the scenario was completed, the simulation faculty member conducted a 20-minute debriefing utilizing the Debriefing With Good Judgment approach (Rudolph et al., 2006). Next, two different students actively participated in the same 15-minute scenario. The goal was that their performance would improve after watching their peers and participating in the debriefing conversation. A second structured debriefing took place after the scenario was completed. During this second debriefing, the actress who played the SP also gave feedback to the learners. After the simulation, learners completed the Simulation Effectiveness Tool-Modified (Leighton et al., 2015) and the open-ended question via REDCap survey: “Do you have any comments about today’s simulated clinical experience?” Responses were brief yet constructive, such as: “The clinical experience was very realistic and helped me understand the severity of mental health importance even more”; “It was a great experience and it helped me learn more about mental health and how to address it!” Based on learner feedback, this simulation-based experience is one approach that can help bridge the knowledge gap regarding mental health and adequate screening for undergraduate nursing students. It allows students to apply newly acquired screening skills to a real-world situation within a safe and controlled learning environment.