International Journal of Healthcare Simulation

Background:

Pre-registration nurses (students) must be prepared to be part of a cardiac arrest team at a moment’s notice. Basic Life Support (BLS) must be performed proficiently and accurately. Proficient performance relies on repetitive practice, but time without practice results in skill decay [1]. Mental simulation offers the opportunity for repetitive, solitary, deliberate practice. Mental simulation is a quasi-perceptual experience in the absence of stimuli and overt physical movement [2]. Mental simulation has been well researched within healthcare education with promising results. Mental simulation has previously been shown to objectively improve performance of cardiopulmonary resuscitation (CPR) skills [3]. We aim to: 1) understand how participants integrate mental simulation into their busy lives over several weeks; 2) understand how the participants experience imagining a cardiac arrest and what this means to them; 3) and understand the value that students place on experiencing cardiac arrest and life-support education through mental simulation.

Methods:

Phase-1 was the design of a mental simulation script. The protocol was engineered to assist the students in creating functionally equivalent, high-fidelity images. Phase-2 was a qualitative interview study undertaken from a constructionist perspective. Eleven pre-registration nurses were asked to use the mental simulation protocol for 4-weeks. At the end of this period, semi-structured interviews and thematic analysis were employed to co-construct an understanding of student perceptions.

Findings:

Several themes were identified (Table 1). The participants were motivated to undertake the mental simulations mainly due to feelings of low self-efficacy. These motivations created the volition required to problem-solve and make decisions that overcame environmental and time management challenges. The scripts assisted participants in coding images evoked from the language within the script narration. Unique to the participants, these images created individualised, emotionally laden, authentic scenarios high in psychological fidelity. This generated a realistic scenario akin to a real-world practice experience. Mental simulation acted as a reflective tool, and reflective practice allowed the participants to demystify the complexities of cardiac arrest life-support processes, leading to increased self-efficacy. Whilst CPR practice has been objectively shown to increase skill, these findings show the processes that occurred during learning (Figure 1).

Table 1:

Theme and subtheme definitions

Figure 1:

Representation of the learning process during mental simulation

Conclusion:

Using mental simulation creates an authentic cardiac arrest learning experience. It creates self-efficacious, knowledgeable students who are ready for clinical practice. The author recommends mental simulation adjuncts mandatory BLS training within their organisation. Mental simulation could be rolled out to other staff groups, however, more mental simulation research into its efficacy is required.

References

1. Roel S, Bjørk IT. Comparing Nursing Student Competence in CPR before and after a Pedagogical Intervention. Nurs. Res. Prac. 2020;2020:1–6.

2. Arora S, Aggarwal R, Sirimanna P, Moran A, Grantcharov T, Kneebone R, Sevdalis N, Darzi A. Mental practice enhances surgical technical skills: a randomised controlled study. Ann Surg. 2011;253(2):265–70.

3. Fountouki A, Kotrotsiou S, Paralikas T, Malliarou M, Konstanti Z, Tsioumanis G, Theofanidis D. Professional Mental Rehearsal: the Power of ‘Imagination’ in Nursing Skills Training. Mater Sociomed. 2021;33(3):174–178