Simulation Design to Support Nursing Students’ Mental Health
- Jennifer McKeel
- Kristen Ambrose
In response to the 2023 State of Nursing survey by nursing education and advocacy group Nurse.org, 81 percent of nurses surveyed said they have experienced burn out and that their mental health has suffered during the past year.
At HKS, we believe supporting mental health should be a primary concern of programmers, planners and designers of nursing education space. As we celebrate National Nurses Month, we are especially concerned with how design can promote mental health and wellness in the nursing and allied health professions.
Actively teaching wellness strategies in nursing schools and creating spaces that allow students to utilize these strategies will equip nurses with the skills necessary to prioritize their mental health as they enter the workforce.
Rethinking simulation center design is one way to accomplish this. By updating the simulation experience to incorporate spaces and amenities to support mental health and well-being, HKS is investing in nurses and prioritizing their overall health.
A New Model for Simulation Center Design
Simulation laboratories can be stressful environments for nursing students. In a simulation lab, students enact real-world healthcare scenarios, in order to practice skills and demonstrate proficiency in patient care.
The traditional model for a simulation center prioritizes efficiency in the simulation process. This model focuses on providing realistic patient room environments supported by control rooms, ample storage and support space and room for systems such as audio-visual and information technology equipment.
Based on our own research and a review of the literature on simulation center design and operations, HKS has developed a new simulation center sequence – one designed to create an environment of psychological safety throughout the immersive learning experience.
This enhanced simulation center environment incorporates design features and amenities to support students’ health and well-being. In addition, it augments the traditional simulation center layout and flow with non-traditional spaces designed for wellness. Moments that inspire health and wellness can be integrated into the environment without adding significant area or cost.
General Education Space
The general education space is meant to equip students with the skills they need to make the most of the simulation lab experience. Creating rooms where students can relax nearby, but outside, the simulation center allows these rooms to remain open for student use 24 hours a day. The HKS-designed Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation (OSU COMCN) in Tahlequah, Oklahoma, includes peaceful relaxation and reboot rooms in the school’s general education area that serve as restorative spaces for students. The design of the graduate medical education space at Los Robles Regional Medical Center in Thousand Oaks, California, also by HKS, features a dining area, comfortable seating and outdoor views.
Simulation Center Entry Zone
On entering the simulation center, students may need to secure their belongings, review procedure notes, hydrate, eat a snack or use the restroom. Secure lockers; comfortable, flexible seating that allows for individual reflection or collaborative work; adjacent restrooms and a water bottle filler are design features that can help put students at ease, so they can focus on themselves and their performance in the lab.
This approach is demonstrated in HKS’ design of the entrance zone to the simulation center at a new international medical college. The design features lockers and a variety of individual and group seating areas, along with plants and a soothing color palette to enhance the nurturing environment.
Prebriefing Zone
Prebriefing is a quick (approximately 10-minute) information session meant to prepare students for a simulation lab activity.
A prebriefing zone should be considered a fundamental part of the simulation process. Creating a dedicated space to engage students prior to a simulation exercise helps establish that the simulation lab is a psychologically safe environment.
When prebriefings are conducted in a corridor, transitional space or an area designed for another activity, students can be disadvantaged. They may not be able to see, hear or focus well enough to prepare properly for the upcoming assessment.
The design of OSU COMCN includes a separate prebriefing room with comfortable seating and a distraction-free environment. The HKS-designed medical school on the Centro Medico ABC medical campus in Sante Fe, Mexico, has an area with a table and chairs where students can learn about an upcoming simulation exercise. A nearby doorway provides immediate access to an outdoor respite space.
A study published in the research journal Clinical Simulation in Nursing showed that students who engaged in a mindfulness exercise following prebriefing, immediately prior to beginning a simulation exercise, reported feeling a sense of calm that was not typical of their previous experience in the simulation center.
Meditation space should be designed to offer a variety of relaxation activities. These can include larger spaces for group meditation and individual pods for students who prefer a private meditation experience.
Simulation Labs
Because real patients are not treated in simulation labs, simulation lab environments do not typically include the design features associated with actual patient treatment spaces. Design details such as daylight, nature views and soothing color palettes can improve the simulation lab environment and create a more mindful experience for students.
Debriefing Zone
Debriefing after a simulation exercise is a critical step in the simulation process. The goal of a simulation exercise is to promote reflective thinking. To learn from a simulation, students must be able to integrate the experience with conscious consideration of the activity.
A safe debriefing environment is critical to helping facilitators observe learners’ behavior, encourage open discussion and reflective thinking, provide appropriate feedback and aid students in responding to unanticipated situations.
Dedicated rooms are a necessary and well-established standard for debriefing. Prebriefing and debriefing can occur within the same space to create a more efficient floorplan if the circulation sequence is arranged so that the prebrief/debrief zone is positioned to serve both functions well.
Creating different sizes of debriefing spaces – such as a small room for an instructor to meet with one or two students and larger rooms for various-sized groups – allows the debriefing environment to adapt according to need.
Research into best practices for simulation lab debriefing shows that this process should be conducted in an environment that allows for privacy, trust and confidentiality. Acoustical treatments and window coverings can help maintain visual and auditory privacy.
Debriefing spaces should also provide students with access to areas where they can regroup or receive support if they become distressed due to unwelcome outcomes from a simulation exercise. In terms of adjacency, this may include access to a relaxation space or restroom, a smaller debriefing room or office, or nearby faculty/staff office areas.
Debriefing rooms should be positioned such that students can exit the simulation laboratory suite without interrupting simulations in progress. HKS included multiple doorways leading in and out of the debriefing space at City University of New York Lehman College Nursing Education, Research and Practice Center, to allow students to exit the simulation center without crossing back into the simulation labs.
Commitment to Health and Wellness
Our commitment to student health and wellness extends to every environment along nursing students’ journey to graduation. The integration of these wellness interventions and moments for mindfulness can help improve students’ simulation experience, decrease their anxiety and contribute to better learning outcomes, for greater student success.