Effect of Clinical Simulation on Suicide Care Competency and Suicide Stigma Levels of Psychiatric Nursing Students

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).