Section Seven

Simulations Resources

According to the CASN’s Practice Domain for Baccalaureate Nursing Education: Guidelines for Clinical Placements and Simulations (2015), the challenge of securing clinical placements for students has driven a search for alternative strategies for practice experiences. Placements have become wide-ranging (Smith, Corso & Cobb, 2010), and simulation is being increasingly used to prepare students for practice. Some educators see simulation as valuable learning opportunities that are complementary to clinical placements, others have introduced it as a substitute.

“While both clinical placements and simulation provide opportunities for students to develop practice outcome expectations, there are some important differences in the practice experiences they offer. As a result, there are also some differences in the nature of the learning they foster” (CASN, 2015, p. 9). Students in clinical placements can experience unplanned, unpredicted and uncontrolled events that can provide teachable moments. This is helpful for experiencing reallife scenarios; whereas in a controlled simulation nurses can make mistakes without real-life consequences and learn from them. The expert panel recommends that simulation should be used to augment clinical placement opportunities and not replace them.

A useful tool that shows how the differences between the experiences offered by simulation and by clinical placements affect the nature of the learning they foster can be found in the CASN’s Guidelines for Clinical Placements and Simulations (2015), Table 3.

Simulations in Mental Health, Illness and Addiction Practice

Students should have some foundational theory based concepts prior to engaging in a simulation experience. The length of the simulation is directly related to the type of simulation and the learning objectives. The following demonstrates the type of simulations, factors to be considered and proficiency of instructors in simulation and pedagogy approaches that can be used.

Selection of the simulation

There are three major levels of simulation fidelity: low, medium and high.

  • Low fidelity—used to practice psychomotor skills, e.g., a foam pad simulator used to practice intramuscular injections.
  • Medium fidelity—more closely resembles reality and can be used to provide more in-depth learning opportunities, e.g., perfecting an understanding of heart sounds.
  • High fidelity—sophisticated and mimics real life, e.g., computer or instructor controlled mannequins.

When using simulation, the following factors should be considered:

  • Live actors should be used when possible in place of mannequins;
  • Caution against student role-playing that can reinforce pre-existing stigma;
  • Consider the use of multiple simulations that increase in complexity; and
  • Simulation doesn’t have to be expensive to be effective.

Simulation experiences are valuable learning opportunities for students that can help to consolidate their learning. It is important for educators to remember that simulation is not a replacement to clinical practice, however provides a resource to augment theory into the practice environment (RNAO, 2016e). Educators should determine compatibility and select the level of simulation in accordance with the learning objectives for nursing students. Educators may also consider the use of co-creating learning objectives, wherever possible to provide students the opportunity to identify their learning needs. It is also imperative that students are taught the fundamental basics/concepts prior to engagement in a simulation experience.

Quality of instruction

Collaboration between clinical instructors, simulation coordinators and faculty members who teach mental health theory courses improves consolidation of learning. Instructors should be comfortable and proficient with the types of simulation or technology being used. In addition to having knowledge of the learning outcomes, they should have the mental health knowledge and skills needed to integrate theory and practice and debrief with students.

Source: Happell, Gaskin, Byrne & Welch, 2015; Oudshoorn & Sinclair, 2015; RNAO, 2016

Pedagogical Process

When engaging students in clinical mental health and/or addiction simulations, it is important that the placement includes a pre-briefing, the simulation and debriefing opportunities (Jeffries, 2005). The following describes the elements included in each of the stages of pre-briefing, simulation and debriefing.


  • Familiarize students with the technology and equipment.
  • Discuss the learning objectives, participant roles, and details surrounding the simulation scenario.

Actual simulation scenario

  • Students work together in teams and actively participate in the decision-making processes related to the nursing care in the simulated clinical situation.


  • Time is dedicated toward group discussion, feedback and integrated learning.
  • Debriefing is an activity that aims to strengthen the positive aspects of the experience and promotes reflective student learning.

For more information, see Resources in this section.

Teaching and Learning Activities

Refer to respective sections throughout this guide for teaching and learning activities that can be employed in simulation to further support nurses in mental health and addiction knowledge and skill development.





  • Here to Help (2016). Wellness Modules. Retrieved from:
  • Melrose, S. (2002). A clinical teaching guide for psychiatric mental health nursing: a qualitative outcome analysis project. Journal of Psychiatric and Mental Health Nursing. 9 (4), 381-389.



  • Bell, A., Horsfall, J. & Goodin, W. (1998). The mental health nursing clinical confidence scale. A tool for measuring undergraduate learning on mental health clinical placements. The Australian and New Zealand Journal of Mental Health Nursing, 7, (184-190).
  • Canadian Association of Schools of Nursing. (2015). Practice domain for baccalaureate nursing education: Guidelines for clinical placements and simulation. Ottawa: CASN.
  • Cant, R. & Cooper, S. (2011), The benefits of debriefing as formative feedback in nurse education. Australian Journal of Advanced Nursing, 29 (1), p.37-47.
  • Dufrene, C., & Young, A. (2014). Successful debriefing — best methods to achieve positive learning outcomes: A literature review. Nurse Education Today, 34(3), 372-376.
  • Fiedler, R., Breitenstein, S. & Delaney, K. (2012). An assessment of students’ confidence in performing psychiatric mental health nursing skills: The impact of the clinical practicum experience. Journal of the American Psychiatric Nurses Association, 18, 244–250.
  • Ganzer, C.A. & Zauderer, C. (2013). Structured learning and self-reflection: Strategies to decrease anxiety in the psychiatric mental health clinical nursing experience. Nursing Education Perspectives, 244-247.
  • Garrett, B.M., MacPhee, M. & Jackson, C. (2011). Implementing high-fidelity simulation in Canada: reflections on 3 years of practice. Nurse Education Today, 31(7), 671-676.
  • Happell, B. & Platania-Phung, C. (2012). Mental health placements in a general health setting: no substitute for the real thing! Journal of Clinical Nursing, 21, 2026-2033.
  • Happell, B., Gaskin, C., Byrne, L., & Welch, A. (2015). Clinical placements in mental health: A literature review. Issues in Mental Health Nursing, 36, 44-51.
  • O’Brien, L., Buxton, M., & Gillies, D. (2008). Improving the undergraduate clinical placement experience in mental health nursing. Issues in Mental Health Nursing, 29, 505-522.
  • Oudshoorn, A. & Sinclair, B. (2015). Using unfolding simulations to teach mental health concepts in undergraduate nursing education. Clinical Simulation in Nursing, 11, 396-401.
  • Page-Cutrara, K. (2014). Use of Prebriefing in Nursing Simulation: A Literature Review. Journal of Nursing Education, 53(3), 136-141.
  • Tratnack, S., O’Neill, C. & Graham, P. (2011). Immersion experience in undergraduate psychiatric mental health nursing. Journal of Nursing Education, 50, 532–535.
  • Waldo, N. Hermanns, M. & Lilly, M.L. (2014). “A day in the life:” A simulated experience. Journal of Nursing Education and Practice, 4(1), p. 88-95.
  • Woodley, L. (2015). Clinical teaching in nursing. In M. H. Oermann (Ed.), Teaching in Nursing and Role of the Educator (pp.141-161). New York, NY: Springer Publishing Company