Received: 11 September 2023 Revised: 28 October 2023 Accepted: 06 November 2023

DOI: 10.48309/jmpcr.2023.182603

FULL PAPER

Simulation of mental status examination (MSE) on

skills to interpret findings, self-confidence, and
satisfaction with learning among nursing
students: a randomized control pilot study
Prakash Palanivelu |Regidor III Dioso*

Department of Nursing, Lincoln University

College, Malaysia A Randomized control pilot study was conducted to investigate
the effect of simulation of the Mental Status Examination on skills
to interpret findings, level of self-confidence, and satisfaction with
learning among nursing students. Two nursing colleges were
randomly allocated into interventional and control groups. The
data has been obtained from the 20 nursing students of each
group. Audio simulation has been administered to the
experimental group and lecture method teaching has been
administered to the control group. Pre-recorded Case Scenario
Audiotapes are used to assess the skills to interpret the alteration
in thought, perception, and cognition before the simulation.
Student satisfaction and self-confidence in learning scale
developed by the National League for nurses, Washington, is also
used in this study. SPSS-21 was used to analyze the data and
paired ‘t-test was done to identify the effectiveness of the
simulation. The results reveal that both the experimental and
control group teaching sessions were found to be significant since
the p-value is <0.05. However, in the descriptive statistics
experimental group students were more satisfied with the
learning and felt more self-confident after the simulation-based
teaching of the mental status examination. Thus, the audio-
simulation technique was found useful in teaching the mental
status examination.

*Corresponding Author: KEYWORDS

Prakash Palanivelu
Simulation; mental status examination; nursing students; self-
confidence; satisfaction with learning; innovation in teaching.
Tel.: +966-567591486

Introduction help the nursing students to develop skills to

interpret the findings, self-confidence, and
Innovation in teaching methods is a vital factor satisfaction with learning ability. This will also
for effective teaching. The simulation will improve self-confidence and increase the
depict real-life situations and so it helps the satisfaction with learning.
student to understand, interpret, and analyze Marie-Aude Piot et.al (2021) mentioned
the subject in a better way. Often students find that simulation-based education is mostly
it difficult to understand the mental status considered as a highly technology-based tool
examination since, the diagnosis mimics the because of its origin in aviation, which has
same, whereas the student should understand been mirrored by its development in
the differences accurately. The simulation will

J. Med. Pharm. Chem. Res. 5 (2023) 1204-1216 P a g e | 1204

 P a g e | 1205 P. Palanivelu and R. III Dioso

technical-based medical specialties such as scenarios to meet the therapeutic

anaesthesiology, obstetrics, and surgery. This communication and psychological needs in a
might motivate psychiatric educators to adopt wide range of patient care settings.
this teaching strategy with students. Vital Psychological well-being is vital in all areas of
aspects of clinical educators might encounter nursing practice in terms of rendering holistic
diverse experiences where the patient care. An undergraduate nursing
communication processes have significant program must cover all aspects of mental
consequences, which is specifically true in health assessment and its intervention. The
psychiatry, according to simulation-based goal of this project was to develop an
education. This can help the research Undergraduate curriculum that would
participants investigate the severe effects that consider the mental health requirements of
relationships and communication can have on patients not just in acute care psychiatric
an individual’s health and their experiences in facilities but also in medical-surgical
receiving treatment. As a result, simulation specialties, maternity wards, and community
education is not just another technological settings. Durting the lifetime, mental health
innovation or a by-product, rather it is was a topic that would be included in the
considered as a sophisticated pedagogical curriculum. The creation of instructional
approach that has been deeply rooted in the methods that lead to safe practice was one of
holistic approach that has been promoted by the objectives. Additional scenarios will be
the World Psychiatric Association in constructed in the upcoming academic year,
continuity with the medical tradition of the with a total of five simulations already created.
therapeutic praxis, as explained by the Greek Alcohol withdrawal, end-of-life care, post-
philosophers, namely Socrates and traumatic stress disorder, postpartum
Hippocrates, both of them emphasis on the depression, serotonin syndrome,
patient as the whole person and relationship benzodiazepine overdose, elder abuse,
was mentioned to be the crucial means of care. depression among veterans, and geriatric
In a setting inspired by performing arts, depression are the topics covered. Every case
simulation-based education might encourage scenario includes the Quality and Safety
the learners to participate more intensely and Education for Nurses (QSEN) competencies.
personally. It also provides the chances for Providing safe care to the patient by
having out-group reflection and enhancement identifying risk factors and using clinical
of knowledge that are remarkable in decision-making to establish prioritized
communities and groups as explained by the nursing interventions are the overall learning
anthropologists, systemic approaches, and the objectives for undergraduate nursing students
experts involved in the mental health facilities. to initiate and carry out an appropriate mental
Simulation-based education is said to be a status assessment using therapeutic
versatile cultural artifact which further communication. The methodology with the
creatively appropriated in response to the appropriate assessment tools has been
variety of learning demands in the variable created to produce the pertinent
contexts and cultures, both present and future. documentation. Anecdotal comments and ten-
Michelle Beckford (2013) focused on the question surveys have been administered
decentralization of psychiatric concepts in before and after the simulation has been done
undergraduate nursing education which has to evaluate the learning objectives. Pre-tests,
been advocated by both the American post-tests, and scenario creations were made
Psychiatric Nurses Association and the with the use of Quality and Safety Education
International Society of Psychiatric Nurses. for Nurses (QSEN) skills. Following the
The author created several simulation simulation, students expressed their ability to
Simulation of mental status examination … P a g e | 1206

relate the didactic material to their clinical all levels of education and occupations. The
experiences. results were compiled and presented using a
Beryl Mansel and Keith Bradley-Adams framework for instructional design and a
(2017) stated that there should be the goal of cognitive task analysis. For data extraction
nurse lecturers to design learning and analysis, a total of sixty-one papers from
opportunities that link theory and practice. seventeen nations covering six academic fields
The Nursing and Midwifery Council advises and three educational levels were found. Most
that the educational programs created must studies were conducted in undergraduate
prepare the nurses for practice and should psychiatric education, were from the United
offer a flexible as well as a blended approach States of America, and were presented as case
to the learning process using the complete studies for instructional purposes. Few
spectrum of contemporary teaching strategies articles explained the curriculum's
and delivery techniques. The use of simulation instructional design. The efficiency of various
as a teaching and learning tool was advised to elements of instructional design was not
strengthen the connection between theory compared in any of the experiments. At each
and practice. For undergraduate students, task area (knowledge, skills, and attitudes)
studying mental health nursing, the primary and at each stage of an instructional design
author of this article created the simple process the learning activities were plotted. In
mnemonic "I AM A STAR" to help them most studies, role-playing exercises, and
remember the elements of the mental state digital learning resources (videos and virtual
examination (MSE), a core observational patients in more recent publications) were
assessment in mental health nursing. The I AM used in conjunction with introductory
A STAR mnemonic and an observational seminars or lectures. To conclude, all task
simulation were utilized in the Mental Status domains of the psychiatric interview and
Examination teaching workshop and have mental status evaluation need to be
been described by them. The teaching considered by psychiatry educators. There is
workshop was imaginative, interesting, and currently a dearth of empirical research on the
well-received by the students. The I AM A development of expertise and the use of
STAR mnemonic is suggested by the authors instructional design frameworks in the health
as a helpful assessment tool for certified care setting.
practitioners and nursing students. The field of simulation education can also
Eric Lenouvel (2022), conducted the greatly benefit from and contribute to clinical
scoping review regarding the instructional educators in the field of psychiatry because
design strategies to teach the mental status they have extensive clinical experience in the
examination. A key component of the intrapersonal, interpersonal, and relational
psychiatric clinical interview is the psychiatric dimensions of care as well as highly developed
mental status assessment. However, despite communication skills which can be applied
its significance, evidence-based instructional from clinical work to the educational setting.
design has not received much attention. To Physicians and patients should interact with
find design techniques that have been applied this potent pedagogical tool and the field of
for instructing the psychiatric interview and simulation education can profit from its
mental status evaluation to health continued development and use within mental
professionals, this study analyses the health education.
literature from an instructional design An examination of the patient's mental
viewpoint. Searches were conducted through health must be part of the nurse's overall
various databases, reference books, and the physical evaluation of the patient. The
grey literature to find pertinent articles from assessment could happen right away or during
 P a g e | 1207 P. Palanivelu and R. III Dioso

admission. The patient's overall awareness the improvement of the individual’s attitudes,
and response should be examined as part of empathy, and knowledge related to mental
the mental status examination. One may also disease. The experiential learning of virtual
consider the patient's orientation, intelligence, reality-based simulation shows empathy and
memory, judgment, and mental process. The attitude in healthcare education. Virtual
patient's behavior and mood should be reality-based stimulation has a strong impact
evaluated concurrently. When there are on the users’ empathy. Need for future
discernible anomalies in the mental status research studies require a more in-depth
assessment, the patient care plans frequently examination of the effect of empathy and
need to be changed. attitude of individuals with a healthcare
Yanchen Liu et al. (2022) conducted the background and in teaching the wide range of
study to determine the feasibility of detecting mental disorders such as depression and
mental and cognition with the use of artificial anxiety disorder.
intelligence-based mental status assessment.
Artificial intelligence-based automated Need for the study
technologies that track mental health are few.
Andres Martin, Asaf Jacob, Robert Krause, and
An essential technique used by mental health
Doron Amsalem (2020), researched to explore
professionals to evaluate mental health is the
the effectiveness of mental status
mental status evaluation (MSE). MSEs are
examination. A patient's behavioral and
currently only performed by licensed experts,
cognitive information is gathered using a
which presents a challenge for patients in
standardized process called a mental status
underserved and rural locations. As the first
examination (MSE). Like a physical
interactive MSE platform, we suggest an AI-
examination, it offers a structure for the
based personal online mental state test
methodical collection of clinical data. The MSE
(aiMSE). Users can utilize aiMSE to self-
is a fundamental skill of undergraduate
administer MSEs at home using just a camera
medical education (UME) and a professional
microphone and a web browser. With the use
activity that can be trusted in clinical
of the multimodal picture, audio, and natural
psychology. Video clips of fictitious patients
language processing algorithms, aiMSE can
showing three persons with schizophrenia,
identify indications of anomalies in mental
obsessive-compulsive disorder, and bipolar
functioning and suggest that a mental health
illness, respectively. For each disease, we used
professional investigates them further. Our
three brief video clips to show an increasing
14-person study provides evidence that it is
number of psychiatric symptoms. The nine
possible to identify a variety of symptoms that
video clips served as calibrated stimuli for
are frequently present in individuals who have
learners who had to recognize the MSE's
had changes in their mental or cognitive
components using an online tool. Results
abilities.
reveal that 37 students volunteered to test this
Wai Hin Wan and Angie Ho Yan Lam (2019)
online exercise. When it came to the overall
conducted a literature review to explore the
identification of MSE components,
effectiveness of virtual reality-based
experienced learners outperformed novice
simulation on the health professions
ones (p.001). According to the ABC-STAMPS
education related to mental illness. The four
(appearance, behavior, cooperation; speech,
databases were checked from 2007 to 2018
cognitive process and content, affect mood,
and 1034 articles have been identified in the
perceptions, and suicidality) rubric, they were
database. Six articles have been included in the
able to recognize certain MSE components.
review. Findings show that there is a clear
Students were pleased with the formative
relation between the virtual simulation and
Simulation of mental status examination … P a g e | 1208

didactic exercise and educational complement functions," and mental status examination
provided by this video-based scoring tool, subsets were frequently used. The following
which was simple to apply in a UME setting. mental functions were considered by all
Rocha Neto, Estellita-Lins, Lessa, and authors: consciousness, perception, thought,
Cavalcanti (2019) highlighted the Narrative memory, attention, orientation, and volition.
Review of Brazilian Descriptive Mental status examination proficiency is
Psychopathology regarding the Mental State required for psychiatric competency. Official
Examination. Here, the Mental State paperwork is vague when it comes to
Examination (MSE) is compared to a physical performance and recording criteria. MSE data
examination as a valid means of gathering was often collected using descriptive
objective data. Concerns about psychiatric psychopathology. Over time, there was a
clinics, nosology, and the dependability on change from thorough descriptive findings to
diagnostic interview methods act as a source an array of observed problematic features
of good diagnostic strategy and seem to be defined using a mental function checklist.
emerging nowadays. Attempts taken to Clinical practice and research
establish the worldwide diagnosis protocol recommendations should incorporate the
have been either futile or divisive. This establishment of trustworthy mental status
research examines the evolution of examination procedures; yet, current
psychopathology, mental status assessment, psychiatry/neuroscience have overlooked it
and mental function in Brazilian psychiatry because of an overemphasis on interview
during the previous few decades. Research methods. Better mental status examination
methods including searches, interviews, and procedures and bedside expertise in
narrative reviews were conducted to identify psychiatry are required, and they are
systematic methods for conducting mental dependent on the revival of
status examination, mental functions, psychopathological debates and semi-logical
symptom clusters, data observation reasoning, which will allow the reintroduction
orientations, and records. Brazilian of phenomenology-oriented "observational"
psychopathology textbooks were scrutinized techniques.
to visualize if they provide access to Tristan Gorrindo et al. (2013) explored the
consolidated knowledge on psychopathology performance assessment tool using the
evaluation. Results explored that there are simulation-based professional practice
Sixteen textbooks chosen from 49 years. The evaluation. Ongoing professional practice
dominant trend in the Mental status evaluation (OPPE) contains the competency-
examination was descriptive psychopathology based quantitative evaluation of clinical
with a phenomenological orientation. performance. Healthcare institutions need to
Concepts developed from several traditions, design assessments to measure the clinical
most of which lacked standard vocabulary, competencies, which are scalable and found
suggested some author disagreement. easy for clinicians. A psychiatry department
Although there were clear recommendations implemented the web-based psychiatric
for patient observation and how to acquire simulation program on violence risk
objective data, MSE standardization efforts assessment as the tool. Out of 412 doctors at
were lacking. The major mental status the psychiatry department, 410 doctors have
examination record strategy was a detailed completed the online simulation. Research
description of mental function problems, with participants have received the e-mail
no agreement on how to summarize and reminder along with instructions to use the
record this data. In a report of the study, online simulation session effectively.
mental strata were grouped into "mental Computer simulation assessment tool was
 P a g e | 1209 P. Palanivelu and R. III Dioso

used. Research participants visualized the control group design has been adopted with
introductory video and they were asked to third-year undergraduate nursing students on
perform the risk assessment. The action has a psychiatric nursing practicum course
been paired with the corresponding video divided into an experimental group (30
with the standardized patient. Participants samples) and a control group (23 samples).
have been scored based on actions performed The experimental group attended the
within the simulation (measure one) and the instructional video for mental status
responses towards asking out the open-ended examination with case-based learning through
questions to integrate summative information social media, namely “Facebook” while the
from the simulation session (measure two). control group received the traditional
Results reveal that, out of 410 doctors, 93% teaching method only. Data was analyzed
passed Measure 1, 88% passed Measure 2, and using descriptive statistics, the Mann-Whitney
1.2% failed both measures. 18.3% of U test, and the Wilcoxon Signed Rank Test.
participants were referred for the focused Results reveal the efficacy of instructional
professional practice evaluation (FPPE) after video for mental status examination was
failing either Measure 1, Measure 2, or both. 78.5/81.3 which was higher than the criterion
Overall, the web-based simulation and the e- of 75/75. The median score of knowledge and
mail engagement tool are said to be the self-efficacy in the experimental group were
scalable and best way to assess doctors in significantly higher after than before learning
Ongoing professional practice evaluation and and there were statistically significantly
to identify those who require focused higher knowledge and self-efficacy scores in
professional practice evaluation the experimental group than the control group
Andres Martin et al. (2020) conducted a and nursing students’ satisfaction was at a
study to explore the effectiveness of teaching high level. This instructional video for mental
mental status examination using video clips of status examination collaboration with case-
simulated mentally ill patients. Seventy-five based learning may be used to raise the
medical and seventy-eight nursing students students’ knowledge and self-efficacy
(one hundred and fifty-three students) have regarding the mental status examination.
participated in this study. The intervention Furthermore, studies with repeated measure
group has shown improved knowledge and designs with a bigger sample size have been
competence in Mental status examination suggested.
compared with the control group. Hence, the Benjamin T. Griffeth, Bogan Brooks, and
videos depict psychopathology to be an Adriana Foster (2017) developed the twelve
effective complement to teaching mental Entrustable Professional Activities (EPA) to
status examination on recognizing the signs ensure the adequate skills of medical college
and symptoms. graduates. They developed a tool to assess the
Treenut Pummanee et al. (2023) conducted mental status exams conducted by future
a quasi-experimental study to explore the psychiatry residents. The tool contains both a
effectiveness of instructional videos for video of a psychiatrist who conducted an
mental status examination on knowledge, interview with a patient and the mental status
level of self-satisfaction, and self-efficacy for exam rating sheet may be used when students
mental status examination of patients among present the mental status exam findings
undergraduate nursing students. Here, case- verbally or in writing mode. They included the
based learning has been compared with feedback from the psychiatry educators in the
traditional learning without applying the annual meeting held at the Association for
instructional video for mental status Medical Student Educators in Psychiatry.
examination. Two-group pretest-post-test Results reveal that there was a significant
Simulation of mental status examination … P a g e | 1210

difference between the third- and fourth-year Hence, it is vital to teach the mental status
medical students in describing the cognitive examination to nursing students in an
exam. Overall, this tool allows for effective way with the use of simulation
standardizing the mental status presentation techniques. Here, the researcher adopted the
done by senior medical students who need to audio-simulation teaching of mental status
specialize in vpsychiatry. examination to explore its effectiveness.
Machelle Skinner and Cristi Campbell
(2019) conducted a study exploring the Research objectives
simulation effect on student perception of
1. To investigate the effect of simulation of
mental health and the survey responses
mental status examination on skills to
related to mental health which predict
interpret findings.
the Assessment Technologies Institute (ATI)
2. To investigate the effect of simulation of
Mental Health Exam scores. A revised version
mental status examination on self-confidence.
of the Mental Health Nursing Education
3. To investigate the effect of simulation of
Survey was used to examine nursing students'
mental status examination on satisfaction
(n=63) perception of mental health.
with learning.
Descriptive statistics described the sample
population and responses to survey items.
Hypothesis
Independent t-tests analyzed the
sample. Linear regression predicted outcomes H1: Simulation-based teaching of mental
on the ATI Mental Health Exam. Results reveal status examination will improve the skills to
that the ATI Mental Health Exam was shown to interpret the findings, self-confidence and
significantly correlate with survey answers satisfaction with learning among nursing
about anxiety (p =0.047) and safety (p students.
=0.003). The sum of the replies to these survey
statements may be used to predict a variation Operational definition
in ATI Mental Health Exam scores of 15.4%.
According to this study, ATI Mental Health Simulation: In this research study, the term,
Exam scores rise when students receive “simulation” refers to the practical-oriented
mental health care and feel secure and less training of mental status examination with the
stressed. Students may become more at ease help of depicted reality-based situations.
with mental health treatment thanks to Mental Status Examination (MSE): In this
simulation. research study, the term, “mental status
Rachel M. Voss and Joe M. Das (2022) state examination” refers to the assessment of a
that the nurse should observe the patient's mentally ill patient thoughts, cognition, and
general demeanor, posture, and facial features perception
while gathering a mental health history. They Critical thinking: In this research study,
should also pay attention to general conduct, the term, “critical thinking” refers to the
as well as the way that the brain works and logical thinking technique with the use of
what it is inclined toward. Communication analysis and interpretation of correct
prowess, memory, intellect, and judgment are symptoms in mental status examination.
further noteworthy factors. If the patient is Knowledge: In this research study, the
suicidal or in danger of self-harm, one can also term, “knowledge” refers to the amount of
make that determination. Having tact is information known after the simulation
essential for nurses. In the chart, everything teaching technique.
must be documented. At all times, it is critical Satisfaction with learning: In this
to ensure the patient's and nurses' safety. research study, the term, “satisfaction with
P a g e | 1211 P. Palanivelu and R. III Dioso

learning” refers to the learners how far they 1. To assess the required skills to interpret the
are being satisfied after completing the findings of mental status examination: Pre-
learning process of mental status examination. recorded Case Scenario Audiotapes have been
played to assess the skills to interpret the
Variables of the study
alteration in thought, perception, and
Independent variable:“Simulation” is the cognition. Five short case scenarios in each
independent variable in this research study. section (thought, cognition, and perception)
Dependent variable: “Skills to interpret have been given to the participants online
findings, self-confidence, and satisfaction with within the stipulated timings.
learning” is said to be the dependent variable 2. To assess Student Satisfaction and self-
in this research study. confidence in Learning: a scale developed by
Relationship between the variables: the National League for nurses, Washington,
Simulation training may enhance the skills to has been used for the assessment.
interpret the findings of mental status
Validity and reliability of the questionnaire
examination, self-confidence, and satisfaction
with learning the skills to interpret the mental
Content validity has been obtained from five
status examination findings.
experts in the field of Psychiatric Nursing.
Test-Retest Reliability test was done for the
Methods/ instruments for data collection
Pre-recorded audio based questions with the
Population of the study samples before the commencement of the
Pilot Study and the score of Cronbach alpha
Target Population: The Target Population of was 0.81.
this research study is “Nursing Students”. E. Franklin, Paulette, Burns, and
Accessible Population: The accessible Christopher S. Lee (2014) conducted a study
population of this research study is to explore the psychometric properties of the
undergraduate nursing students who are student satisfaction and self-confidence in
pursuing B.Sc. The nursing course at learning scale. Psychometric tests included
Shivparvathi Mandradiar Institute of Health item analysis, confirmatory, and exploratory
Science, Palyakottai, Tiruppur district, and factor analyses in randomly split subsamples,
Texcity College of Nursing, Coimbatore’ concordant and discordant validity, and
Research design: Regarding the research internal consistency. The scales are found
design, Pre-test Post-test Control group design reliable.
has been adopted in this research study.
Sampling technique: Sampling is said to Ethical considerations
be the subset of the population. Regarding the
Ethical consideration has been considered as
sampling technique, “Convenient sampling
the vital part of the research study. The well-
method” has been adopted in this research
structured research proposal has been applied
study.
to the Lincoln University College’s Research
Sampling criteria: Undergraduate nursing
Ethics Committee in Malaysia and the research
students who are willing to participate in the
study has been approved (Ref:
study have been considered as samples. Since
PDF/LUCPDF20211223001/03/2022) on
the research is based on a convenient
March 1 , 2022. Prior written permission has
st
sampling technique, there are no rigid
been obtained from the Principal of the
sampling criteria to select the samples.
College of Nursing, Shivparvathi Mandradiar
Questionnaire used in this research: Institute of Health Science, Palyakottai,
Simulation of mental status examination … P a g e | 1212

Tiruppur district, and Texcity College of cognition, and assessment of perception.

Nursing, Coimbatore to conduct the research Fifteen questionnaires are present in the skills
study on their nursing students. Information Questionnaire (five questionnaires in the
about the benefits of participation in this thought assessment, five questionnaires in the
research study has been explained and assessment of cognition, and five
informed consent has been obtained from the questionnaires in the assessment of
research participants in the Google Form to perception) The audio-based simulation
ensure the willingness of the research training was delivered through an online
participants to participate in this study. platform using the pre-recorded audio
teaching aids in the Google Meet for the
Data collection procedure participants who belong to the experimental
group. Lecture method-based teaching the
Using the Lottery method, the colleges have
mental status examination has been done to
been randomized. Students belonging to
the research participants who belong to the
Shivparvathi Mandradiar Institute of Health
control group. The teaching session has been
Science, Palyakottai, Tiruppur district have
lasted for 45 Minutes. Post-tests were
been allotted to the experimental group.
conducted after the audio simulation-based
Students belonging to Texcity College of
teaching in the experimental group and
Nursing, Coimbatore have been allotted to the
lecture method-based teaching session in the
control group. 40 nursing students have
control group. In both experimental and
participated in the research. Hence, the 20
control groups after the teaching session, a
nursing students who belong to Shivparvathi
scale developed by the National League for
Mandradiar Institute of Health Science,
Nurses, Washington, has been used for the
Palyakottai, Tiruppur district were in the
assessment of student satisfaction and self-
experimental group, and 20 nursing students
confidence in learning about the mental status
belonging to Texcity College of Nursing,
examination.
Coimbatore were in the control group.
Research participants who belong to the Results and discussion
experimental group have the pre-simulation
session (Pre-test, introduction, orientation, Descriptive statistics
and description of the session), simulation
session (assessment of thought, perception, Regarding the distribution of demographic
and cognitive function), and post-simulation variables in the experimental and control
assessment (post-test). Research participants groups, the majority of the samples belong to
who belong to the control group have the Pre- the age group of 17-20 years. All the samples
lecture session (pre-test, introduction, were females and pursuing a B.Sc. nursing
orientation, and description of the session), course. Most of the samples (75%) do not have
Lecture Session (assessment of thought, previous knowledge of mental status
perception, and cognitive function), and post- assessment in the experimental group and
lecture assessment (post-test). (80%) of them do not have previous
Data was collected online using the Google knowledge of mental status assessment in the
form before and after the intervention (audio- control group, as presented in Table 1.
based simulation training). The skills
Questionnaire consists of three components
such as assessment of thought, assessment of
P a g e | 1213 P. Palanivelu and R. III Dioso

TABLE 1 Distribution of demographic variables in experimental and control Group

Experimental Group Control Group
Demographic Variable No. of
Percentage No. of Samples Percentage
Samples
Age Group
19 95 20 100
a. 17-20 Years
1 5 0 0
b. 20 -23 Years
Gender
a. Male 0 0 0 0
b. Female 20 100 20 100
Studying Course
a. Diploma in Nursing 0 0 0 0
b. Bachelor in Nursing 20 100 20 100
Previous Knowledge
about the Mental Status
Assessment
a. Yes 5 25 4 20
b. No 15 75 16 80

FIGURE1 Percentage Distribution of Results after the Teaching Session of Mental Status
Examination

On average, 90% of samples in the based Simulation teaching skills to interpret

experimental group are satisfied with learning the findings of mental status examination. The
and 88% of the samples have obtained self- results of the same is presented in Table 2.
confidence after the simulation session of the The formula of the paired t-test is defined
mental status examination whereas, 87% of as the sum of differences in each pair divided
Samples in the control group are satisfied with by the square root of n times the sum of
learning and 83% of samples have obtained differences squared minus the sum of the
self -confidence after the lecture session of squared differences, overall n-1. The formula
mental status examination, as displayed in for the paired t-test is as follow:
Figure 1.

Inferential Statistics
where,
A paired t-test has been done in this research - Σd is the sum of the differences.
study to explore the effectiveness of audio-
Simulation of mental status examination … P a g e | 1214

- d is the difference between the values of a PowerPoint presentation. 40 Nursing students

single pair, that is one deducted from the (20 students in the experimental and 20
other. students in the control group) participated in
Paired t-test was done to explore the the study. The results reveal that both the
effectiveness of the simulation session. The experimental and control group teaching
results reveal that both the experimental and sessions were found to be significant since p-
control group teaching sessions were found to value is <0.05 However, on the descriptive
be significant since p-value is <0.05 statistics experimental group students were
In the present study, the effectiveness of more satisfied with the learning and felt more
teaching mental status examination using pre- self-confident after the simulation-based
recorded audio teaching aids along with the teaching the mental status examination.

TABLE 2 Results of paired t-test to investigate the effectiveness of simulation

Group Score Mean n SD t Sig.(2-tailed)
Pre-test
14.65 20 2.978
score
Experimental -4.219 .000
Post-test
18.05 20 1.638
score
Pre-test
12.75 20 3.932
score
Control -9.129 .000
Post-test
17.75 20 3.354
score

Recommendations cognition, thought, judgment, consciousness,

memory, and insight. Simulation-based
 A similar study needs to be conducted on a education was helpful as nursing students lack
large scale as per the sample size the chance to acquire skills in interpreting
calculation. mental status assessments. Thus, the audio-
 Sequence of post-test may also be simulation technique was found useful in
conducted after the simulation to teaching the mental status examination. This
determine the retention of skills method of teaching enhances the self-
interpretation on mental status confidence level of students and gives them
examination among nursing students. good satisfaction with learning. Hence, H1:
Simulation-based teaching of mental status
Conclusion examination will improve the skills to
interpret the findings, self-confidence, and
Quality of teaching will improve the learning
satisfaction with learning among nursing
process among students. Clinical learning is a
students have been accepted.
vital aspect of the student nurses and this can
be done through the learning which happens Acknowledgements
in their clinical postings and in the
laboratories. Nurse educators who adopt Heartfelt would like to thank to Dr. Regidor III
innovative teaching methodologies will Dioso, Supervisor of this project at the
facilitate the learning process among students. Department of Nursing, Lincoln University
Mental status examination among patients College, Malaysia. Special thanks to the
was mentioned to important clinical aspect of Management and Nursing students belonging
the Psychiatric Nursing subject. Mental status to Shivparvathi Mandradiar Institute of Health
assessment components include mood, affect, Science, Palyakottai, Tiruppur district, and
 P a g e | 1215 P. Palanivelu and R. III Dioso

Texcity College of Nursing, Coimbatore for [7] E. Lenouvel, C. Chivu, J. Mattson,

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