Evaluation of the Effectiveness of Standardized Patient Simulation as a Teaching Method in Psychiatric and Mental Health Nursing

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Aspects to consider

There are some quite old references used to support this paper, perhaps look at more contemporary evidence to support your work. 

There have been other studies about using standardized patients, how do you feel yours is different? Not sure that the explanation included in your conclusion addresses a unique gap?  Can you highlight something to strengthen how your study is different?

You have used statistical analysis but then written terms such as 'some' and 'many', not sure why?

Some statements not supported by context or clear evidence.

Line 53: Standardized patients are expertly trained-by whom?  Where were these standardized patients from?  Were they volunteers?  You do highlight this as a problem later in the paper where you mention that the standardized patients did not adhere to the written scenario causing confusion.

Lines 56-57:...without causing harm....  This statement is overrating the use of simulation as harm can be caused if a simulation is not planned and run appropriately (review INACSL Standards), reword suggested.

Lines 59-60: ...addresses the unique challenges...  suggest 'can' address the unique challenges.

Line 63: how do you know that participants 'feel at ease'?

Line 71: enthusiasm

Line 72: simulation does not always involve the use of technology, for example using standardized patients.

Line 92: alternative for 'find out'

Line 115: is this course at undergraduate level or are these students already nurses?  Addressed in Line 319, perhaps bring that information to the front.

Section 3.12:  The pronoun 'some' used multiple times however no statistical findings mentioned? There must be statistics available?

Line 327.  Not sure what 'this critical point' is?  Not sure that 'their self-confidence in dealing with real patients experiencing mental health problems following their experience has been addressed in this paper as there is no mention of the types of psychiatric or mental health issues covered during the simulation activities?

Line 344: help prepare them for their real clinical placements.  

Conclusion: Conclusion does not mention any limitations that have been mentioned earlier in the paper, however there does appear to be some slightly exaggerated claims, see below.

Lines 424-426: should these individuals be enrolled in a psychiatric nursing course if they have difficulty forming interpersonal relationships or communicating?  Was there specific feedback from participants about this?

Line 430: You can't really say that student self confidence in dealing with real psychiatric patients increased until they have had the opportunity to actually interact with patients, this would need a survey after clinical placement.  The students may have expressed that they felt better prepared to interact with real patients living with psychiatric illness following their simulation experience?

Comments on the Quality of English Language

Overall, the quality of English language is reasonable, however there are some awkward expressions such as, simulation cannot be used to articulate (line 423).  There are some additional points made in the comments and suggestions for authors above.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Literature was integrated to support previous investigation of topic. 

Abstract was comprehensive.  

Statistical analyses were thorough.   

Student quotes added to support of the overall findings. 

Topic is a beautiful contribution to existing literature for a clinical area that is difficult to secure. 

Beautifully written.  

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The topic is interesting and relevant. In detail:

1. The objective is not included in the abstract.

2.  Keywords should be revised, so that they all correspond to mesh terms.

3. Introduction could deepen the specificity of the simulated patient. 

4. The methodology and inclusion criteria do not explain the nature of the exposure to the technique in question (standardised patient simulation as a teaching strategy), how it was carried out, at what time, etc. - elements that allow us to understand the effectiveness of the contact. 

5. It is important to have ensured ethical review of the project. 

6. Results are described appropriately and descriptively. Correlations are explained. 

7. However, the answers to the open questions are presented as "feedback", but it would probably be relevant to subject them to content analysis or thematic analysis and present categories and/or subcategories. 

8. Discussion of the findings with some other studies does not explain differences (eventually) presents the exposure to simulated patient. 

The paper could be improved, with this revisions (1, 2, 3, 4, 7, 8) 

Author Response

Please find attached.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The paper is now reading much better by adding clarification to some of the content.