Collaboration, Innovative Use of Technology Help Psych NP Students Hone Suicide Prevention Skills

As any behavioral health provider can attest, suicide is a major public health concern in the United States. Suicide rates in this country have climbed by more than a third over the past two decades, and death by suicide stands as the second-leading cause of death of young people, ages 10-34.

A new collaboration between the University of Rochester School of Nursing and the Department of Psychiatry Laboratory of Behavioral Health Skills (LaBHS) takes aim at that rising tide with an innovative approach to educating students in suicide prevention.

In virtual simulation settings with standardized patients, UR School of Nursing Family Psychiatric Mental Health Nurse Practitioner (PMHNP) students can build on their competencies specific to suicide assessment and prevention and augment skills they use in clinical settings with patients.

Susan Blaakman, PhD, RN, PMHNP-BC, FNAP, director of the PMHNP program, along with Joanne Bartlett, MS, RN, PMHNP-BC, instructor of clinical nursing, Julia Mitchell, PMHNP-BC, instructor of clinical nursing, and Catherine Tredwell, DNP, RN, PMHNP-BC, assistant professor of clinical nursing, worked with Wendi Cross, PhD, director of LaBHS, to offer standardized patient experiences in which students and trained clinical actors would participate in scenarios that have been well tested and modified for PMHNP competencies in a telehealth format.

“COVID-19 has shown us that educating students in a telehealth model makes sense,” said Blaakman. “The likelihood of PMHNPs working in telehealth modalities is even higher now, so it is beneficial to have them practice essential skills in that method, as well.”

Over several months, the PMHNP students participated in formative assessments with standardized patients of different ages and genders experiencing various psychosocial issues and stressors. While students learn how to conduct a mental status evaluation in their didactic coursework, the simulation allows them to receive feedback from a “patient” in a low-risk setting before future higher-risk interactions with actual patients.

Prior to each recorded telehealth visit, students received the standardized patient’s history and reason for the visit as if they were in a clinical setting. The students asked questions about the patient's underlying illnesses, family history, current risk, and how to mitigate them with safety planning and prevention resources like the National Suicide Prevention Lifeline at 1-800-273-TALK.

After each session, the standardized patient provided feedback on the student’s engagement and interview skills. Additionally, faculty members evaluated the students on their competencies, attitudes, and satisfaction. The students also completed surveys to gauge their confidence in their skillset.

“These types of practice opportunities and immediate feedback are important to the reduction of harm for our patients,” said PMHNP student Erica Boccia. “Being able to have a no-risk trial with prompt constructive feedback may be the thing that saves a life later.”

“I have never had the opportunity for patients assessing and giving me feedback regarding my performance,” added another PMHNP student, Princewill Fonta. “The standardized patient experience was a good tool to help assess my rapport with patients, my skills, my engagement during the assessment process, and if I`m asking the questions correctly.”

With the success of the project, UR School of Nursing faculty members were eager to pursue ongoing collaboration and interprofessional learning opportunities through the Skills Lab. In June, Blaakman received the news that the school will receive nearly $1 million in support over four years from the Health Resources and Services Administration (HRSA).

She is the principal investigator on a HRSA-funded grant, “Project ENACT: Educating NPs to Address Childhood Trauma,” which will contribute to expanding the behavioral health workforce serving at-risk children and adolescents by increasing the number of skilled master’s-level psychiatric mental health nurse practitioners working with that population.

Using a multi-pronged approach, the grant will help establish the competencies PMHNPs require to effectively employ trauma-informed care and address trauma-associated risk factors for depression, anxiety, and suicidality in youth.

“It’s important work. We know that patients have complex stressors; we know that we need to reach them where they are, and we need to work together to be effective. This is just one piece of becoming more prepared and responsive,” said Blaakman. “My dream is that telehealth will allow other professions to join efforts. I think there are opportunities to grow interprofessional education, and practice, using this model.”