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Nurse Educ Pract. 2013 Nov;13(6):529-35. doi: 10.1016/j.nepr.2013.03.023. Epub 2013 Apr 26.

The distress of voice-hearing: the use of simulation for awareness, understanding and communication skill development in undergraduate nursing education.

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Mental Health Nursing, Faculty of Health, University of Technology, Sydney, Australia. Electronic address:


Role-play scenarios are frequently used with undergraduate nursing students enrolled in mental health nursing subjects to simulate the experience of voice-hearing. However, role-play has limitations and typically does not involve those who hear voices. This collaborative project between mental health consumers who hear voices and nursing academics aimed to develop and assess simulated voice-hearing as an alternative learning tool that could provide a deeper understanding of the impact of voice-hearing, whilst enabling students to consider the communication skills required when interacting with voice-hearers. Simulated sounds and voices recorded by consumers on mp3 players were given to eighty final year nursing students undertaking a mental health elective. Students participated in various activities whilst listening to the simulations. Seventy-six (95%) students completed a written evaluation following the simulation, which assessed the benefits of the simulation and its implications for clinical practice. An analysis of the students' responses by an external evaluator indicated that there were three major learning outcomes: developing an understanding of voice-hearing, increasing students' awareness of its impact on functioning, and consideration of the communication skills necessary to engage with consumers who hear voices.


Consumer; Simulation; Undergraduate nursing; Voice-hearing

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