Key themes: Education (training, assessment, curriculum), Research and development, Quality improvement, Interprofessional collaboration

Academics:

• Miss Amanda Griffin, Senior Lecturer, University of Worcester, amanda.griffin@worc.ac.uk
• Dr. Fazilah Twining, Senior Lecturer, University of Worcester
• Miss Carmina Scott, Lecturer, University of Worcester
• Mrs. Charlie Shaw, Lecturer, University of Worcester

Aims & Objectives:

Amid concerns about the dilution of core mental health nursing skills, the mental health nursing team at the University of Worcester created a high-fidelity simulation for third-year mental health nursing students. The session blended the complexity of real-world practice with professional accountability in a psychologically safe environment. The session’s objectives were to:

• Encourage critical reflection on students’ roles in the care of a patient who died unexpectedly
• Support articulation of clinical reasoning under scrutiny
• Strengthen understanding of decision-making, risk management, and accountability
• Promote emotional resilience and reflective practice
• Reinforce the importance of the mental health nursing skills of risk assessment, therapeutic engagement, and documentation

Details:

The simulation session was structured as a coroner’s court inquest into an unexpected death, concluding a series of scenarios focused on responding to self-harm and a suspended ligature. The simulation was held in a mock courtroom and Law students acted as legal representatives for the family and the NHS trust, while a retired legal professional served as the Coroner. The simulation used a real Regulation 28 report to prevent future deaths, and students were provided with an evidence pack created by mental health nursing team.

A pre-brief took place in the jury room, to orientate students to the task and ensure psychological safety. To facilitate insight into multi-disciplinary care pathways, students were allocated into groups for different clinical roles e.g. community nurse, psychiatric liaison nurse, and psychiatrist. Students were given time in the jury room to review the evidence and prepare responses to potential questions. Each group nominated a spokesperson whom the coroner called to provide evidence through questioning. Following questioning the coroner presented a record of inquest to the students. The simulation concluded a debrief using the DIAMOND tool.

Impacts

Anecdotal feedback from the students indicated that the simulation deepened their understanding of professional accountability, as well as both the procedural and emotional complexities of mental health nursing clinical practice. By presenting evidence to the coroner, the simulation fostered critical reflection on the skills of risk assessment, documentation, and clinical decision-making. Post-simulation students reported improved confidence in articulating clinical decision-making processes. The session also created discussion and increased awareness about the importance of clear and detailed clinical documentation, and the challenges and benefits of shared responsibility in managing complex mental health difficulties across a range of disciplines. The simulation aligns with the Nursing and Midwifery Council’s Code of Practice by promoting safe, effective, and accountable practice. The simulation is also highly adaptable across a range of healthcare settings as the structure allows for the exploration of core issues in healthcare such as accountability, ethical working, clinical decision-making, evidence-based practice, and interprofessional working.

Next Steps

Future iterations of this simulation will take a more longitudinal approach to ensure curricular cohesion and constructive alignment. Students will encounter the patient earlier in their academic journey and engage with them across multiple simulations across various mental health settings. Students will generate an evolving evidence pack from their interactions with the patient, rather than being provided with the pack on the day of the simulation, which will enable them to be challenged to defend their own clinical decision-making from their interactions with the patient. The longitudinal approach will reinforce accountability, emotional resilience, decision-making, and reflective practice, while balancing mental health-specific learning, with an appreciation for interdisciplinary work.

NB the simulation was also supported by Mr Stuart Guy, Senior Lecturer at the University of Worcester