A study into the experiences of pre-registration nurses’ use of mental simulation
Authors:   , White Nicholas Andrew 
Published: September 2022

Pre-registration nurses (students) must be prepared to be part of a cardiac arrest team at a moment’s notice. Basic life-support (BLS), including cardiopulmonary resuscitation (CPR), must be performed proficiently and accurately. Proficient performance relies on repetitive practice, but time without practice results in skill decay, potentially leading to catastrophic memory failure. Annual mandatory BLS updates may not be enough to halt skills decay, nor does it necessarily offer an authentic cardiac arrest experience. Mental simulation offers the opportunity for repetitive, solitary, deliberate practice. Mental simulation is a quasi-sensory or quasi-perceptual experience in the absence of stimuli and overt physical movement (Arora et al., 2011). Mental simulation has been well researched within healthcare education with promising, albeit limited, results. The study aims are to understand: 1) how participants integrate mental simulation into their lives; 2) how the participants experience imagining a cardiac arrest and what this means to them; 3) whether they see value in experiencing cardiac arrest and life-support education through mental simulation and to, 4) make a judgement as to the benefit of mental simulation as an adjunct to physical simulation in learning life-support. This research study consists of two phases. Phase-1 is the design of the PETTLEP framework (physical, environment, task, timing, learning, emotion & perspective) mental simulation script and protocol. A tripartite design was used in which four students were interviewed about their experiences of undertaking CPR in a real-world cardiac arrest. These cues taken from the interviews were used as the basis for the cardiac arrest scenario script. The broader protocol included a basic and advanced audio script, a cardiac arrest point-of-view film, scenario overview and introduction, glossary, and resuscitation algorithms. The protocol was engineered to assist the student in creating functionally equivalent, high-fidelity images, as per the PETTLEP framework (Holmes & Collins, 2001). Phase-2 is a qualitative, interpretivist interview study undertaken from an inductive, social constructionist perspective. Eleven pre-registration nurses were asked to use the mental simulation protocol three times per week for 4-weeks. At the end of the four weeks, semi-structured interviews were employed to co-construct an understanding of their experiences. This study was carried out using qualitative inductive thematic analysis to search for commonalities in the participants’ experiences. Several themes and sub-themes emerged from their mental simulation journey, which helped answer the research questions. The findings showed that participants had busy home lives but were motivated to undertake the mental simulations. These motivations created the volition required to problem-solve and make decisions that overcame environmental and time management challenges. The scripts assisted participants in coding images evoked from the language within the script narration. Unique to the participants, these images created individualised, emotionally laden, authentic scenarios high in psychological fidelity. This generated a realistic scenario akin to a real-world practice experience. The mental simulation acted as a reflective tool, and reflective practice allowed the participants to demystify the complexities of cardiac arrest life-support processes. This led to the closing of knowledge gaps, reduced anxiety at the prospect of being part of a cardiac arrest team, and increased self-efficacy. Using mental simulation creates an authentic cardiac arrest learning experience. It creates self-efficacious students who are ready for clinical practice. The author recommends that mental simulation adjuncts physical mandatory BLS training.