Effect of Clinical Simulation on Suicide Care Competency and Suicide Stigma Levels of Psychiatric Nursing Students
The Effect of Clinical Simulation on Mental Health and Psychiatric Nursing Students' Suicide Care Competency and Suicide Stigma Levels
This study aims to examine the effect of a suicide scenario-based clinical simulation on nursing students' suicide care competency and suicide stigma levels. The study uses a single-group pre-test/post-test (quasi-experimental) design. Nursing students enrolled in a Mental Health and Psychiatric Nursing course at a foundation university in Istanbul, Türkiye, who have not previously participated in a similar simulation, are invited to take part.
Before the simulation, participants complete a set of questionnaires assessing their suicide care competency and attitudes toward suicide stigma. They then take part in a structured simulation session involving a standardized patient portraying a person with suicidal history and risk. The session includes a prebriefing phase, a 15-minute clinical encounter, and a 60-minute debriefing session guided by the PEARLS model. Immediately afterward, participants complete the same questionnaires again.
The purpose of the study is to determine whether simulation-based training improves nursing students' competency in caring for individuals at suicide risk and reduces stigmatizing attitudes toward suicide, and to contribute evidence on the use of simulation in psychiatric nursing education.
Study Overview
Status
Intervention / Treatment
Detailed Description
Design: This study was conducted using a single-group pre-test/post-test quasi-experimental design to evaluate the effect of a suicide scenario-based clinical simulation on nursing students' suicide care competency and suicide stigma levels.
Hypotheses:
H1: Post-test mean suicide care competency scores of nursing students who participate in the simulation will be higher than their pre-test mean scores.
H2: Post-test mean suicide stigma scores of nursing students who participate in the simulation will be lower than their pre-test mean scores.
Population and Sample: The study population consists of 3rd-year students enrolled in the Mental Health and Diseases Nursing course (English Program) at the Faculty of Health Sciences, Istanbul Medipol University, during the 2026-2027 fall semester (N=110). The sample consists of students who had not previously participated in a similar suicide scenario-based simulation and who agreed to participate voluntarily.
Data Collection Tools: A Personal Information Form (9 items; developed by the researchers, covering age, gender, marital status, prior experience with suicidal individuals, self-reported care competency, personal and family history related to suicidal ideation or attempt), the Suicide Care Competence Scale (SCCS; 18 items, 5 subscales; Sun et al., 2014; Turkish validity and reliability by Erfidan & Büyükbayram Arslan, 2026; Cronbach α=0.85), and the Stigma of Suicide Scale (SOSS; 55 items, 3 subscales: Stigmatization, Isolation/Depression, Glorification/Normalization; Batterham, Calear & Christensen, 2013; Turkish validity and reliability by Öztürk, Akın & Durna, 2017; Cronbach α=0.90) were used.
Simulation Intervention: The intervention consisted of three sequential phases - prebriefing, clinical simulation, and debriefing - with identical learning objectives, environment, scenario, and procedures maintained across all participants to preserve intervention fidelity.
Prebriefing Phase: Conducted immediately before the simulation by the principal researcher, introducing the learning objectives, scenario, participant roles, expected timeline, debriefing process, and data collection instruments, and establishing a psychologically safe learning environment. Pre-test questionnaires (Personal Information Form, SCCS, SOSS) were completed at the end of this phase.
Clinical Simulation Phase: Each group of students engaged in an approximately 15-minute encounter with a standardized patient portraying a person with suicidal history and risk, communication difficulties, and nursing care needs. The scenario was set in a clinical inpatient context. Students practiced therapeutic communication and suicide risk assessment within a safe, realistic environment.
Debriefing Phase: A 60-minute structured session guided by the PEARLS (Promoting Excellence and Reflective Learning in Simulation) blended debriefing model, encompassing reaction, analysis, and summary phases. Post-test questionnaires (SCCS, SOSS) were completed immediately after the debriefing. Total session duration was approximately 2 hours.
Data Analysis Plan: Data are analyzed using SPSS 22.0. Descriptive statistics (mean, standard deviation, median, frequency, percentage) are used for quantitative and qualitative variables respectively. The paired-samples t-test is used to compare pre-test and post-test measurements. Pearson correlation analysis is used to assess relationships between variables. Statistical significance is evaluated at the 95% confidence level (p<0.05).
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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-
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Istanbul, Turkey (Türkiye), 34810
- Istanbul Medipol University, Faculty of Health Sciences, Department of Nursing
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Enrolled in the Mental Health and Diseases Nursing course (3rd year, English Program, Istanbul Medipol University)
- Willing to voluntarily participate and provide written informed consent
- No prior participation in a similar simulation-based training on approaching patients with suicidal ideation or risk
Exclusion Criteria:
- Refusal to participate in the study
- Absence during the simulation implementation session
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: Experimental Group
There is one group. All participants received a suicide scenario-based clinical simulation before their psychiatric clinical placement. The intervention consisted of three sequential phases - prebriefing, clinical simulation, and debriefing - with identical learning objectives, environment, scenario, and procedures maintained across all participants to preserve intervention fidelity. |
A structured simulation-based intervention consisting of three phases: (1) Prebriefing: introduction of learning objectives, scenario, and roles; completion of pre-test questionnaires (Personal Information Form, Suicide Care Competence Scale, Stigma of Suicide Scale). (2) Clinical Simulation: a 15-minute standardized patient encounter in which nursing students practice therapeutic communication and suicide risk assessment with a patient portraying suicidal history and risk. (3) Debriefing: a 60-minute structured reflective session guided by the PEARLS model, followed by immediate post-test administration. Total duration approximately 2 hours. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Change in Suicide Care Competency
Time Frame: Baseline (pre-simulation) and immediately after debriefing (approximately 2 hours after baseline)
|
Measured by the Suicide Care Competence Scale (SCCS; 18 items, 5 subscales). Scores range from 18 to 90; higher scores indicate greater suicide care competency. Turkish validity and reliability established by Erfidan and Büyükbayram Arslan (2026); Cronbach alpha=0.85. |
Baseline (pre-simulation) and immediately after debriefing (approximately 2 hours after baseline)
|
|
Change in Suicide Stigma Levels
Time Frame: Baseline (pre-simulation) and immediately after debriefing (approximately 2 hours after baseline)
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Measured by the Stigma of Suicide Scale (SOSS; 55 items, 3 subscales: Stigmatization, Isolation/Depression, Glorification/Normalization). 5-point Likert scale. Turkish validity and reliability established by Öztürk, Akın and Durna (2017); Cronbach alpha=0.90. |
Baseline (pre-simulation) and immediately after debriefing (approximately 2 hours after baseline)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Self-Perceived Care Competency for Suicidal Patients
Time Frame: Baseline only
|
Single-item visual analog scale (0-10) from the Personal Information Form assessing students' self-perceived competency in caring for patients admitted due to suicidal attempt. |
Baseline only
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Merve Geylani, phD, Medipol University
Publications and helpful links
General Publications
- Sun FK, Chiang CY, Chen WJ, Wang RH, Huang HM, Lin HY. Development and psychometric testing of the Suicide Caring Competence Scale (SCCS) for family caregivers in Taiwan. Arch Psychiatr Nurs. 2014;28(4):284-9. doi:10.1016/j.apnu.2014.05.001 Erfidan SC, Büyükbayram Arslan A. Turkish Validity and Reliability Study of the Suicide Caring Competence Scale: A Methodological Study. Archives of Health Science and Research. 2026;13:1-9. doi:10.5152/ArcHealthSciRes.2026.25168 Batterham PJ, Calear AL, Christensen H. The Stigma of Suicide Scale: Psychometric properties and correlates of the stigma of suicide. Crisis. 2013;34(1):13-21. doi:10.1027/0227-5910/a000156 Öztürk A, Akın S, Durna Z. Testing the Psychometric Properties of the Turkish Version of the Stigma of Suicide Scale (SOSS) with a Sample of University Students. Journal of Psychiatric Nursing. 2017;8(2):102-109. Eppich W, Cheng A. Promoting Excellence and Reflective Learning in Simulation (PEARLS): Development and rationale for a blended approach to health care simulation debriefing. Simul Healthc. 2015;10(2):106-115. PMID:25710312 Goh YS, Selvarajan S, Chng ML, Tan CS, Yobas P. Using standardized patients in enhancing undergraduate students' learning experience in mental health nursing. Nurse Educ Today. 2016;45:167-172. PMID:27526302 Del Pozo-Herce P, Ruiz-Lozano RE, Tejada-Garrido CI, Morán-Rodríguez M, Alonso-Sangregorio M, Olmos-Jiménez R. Mental Health Nursing Student's Perception of Clinical Simulation about Patients at Risk of Suicide. Nurs Rep. 2024;14(1). doi:10.3390/nursrep14010049 PMID:38535721 Campbell C, Lugger M. Innovative Approaches to Mental Health Education: Standardized Patients and Tag Team Simulation. Issues Ment Health Nurs. 2025. doi:10.1080/01612840.2025.2474109 PMID:40068187 Shubel L, et al. Standardized Patients to Deliver or Evaluate Suicide Prevention Trainings for Health Professionals: A Scoping Review. Am J Pharm Educ. 2025. doi:10.1016/j.ajpe.2025.101497 PMID:40882819 Bruce E, Shaughne
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- E-10840098-50.04-6898
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Individual participant data will not be shared, as the study involves student participants whose confidentiality is protected under the ethics committee approval. Aggregate findings will be reported in peer-reviewed publications.
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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