BYU Nursing students Catherine Wendel and Grace Edwards stood in front of nursing professionals from across the country at the American Psychiatric Nurses Association (APNA) annual conference in October 2025. They presented on the implementation of a multi-patient, team psychiatric simulation for undergraduate students here at BYU College of Nursing.
As part of their psychiatric care course, nursing students participate in a series of simulations to practice the skills they are learning in the classroom. Their first three simulations are on de-escalation, substance abuse disorders, and trauma. These simulations then build to a culminating, multi-patient simulation of an inpatient psychiatric unit.
This multi-patient, cumulative simulation is unique in psychiatric nursing. When Dr. Michael Thomas didn’t see any other people doing a simulation like this, he stepped in to create one. He and Professor Brandon Thatcher, as the designers and implementors of the cumulative simulation, mentored Catherine and Grace through their research.
Simulation
In this simulation, a charge nurse, a medication nurse, and a psychiatric tech provide care for four patients in an inpatient psychiatric unit. The four patients each have one of the following: bipolar disorder, borderline personality disorder, generalized anxiety disorder, and depression with suicidal thoughts. Over the course of the simulation, each patient experiences different challenges and expresses various needs. The situation tests a number of nursing skills, like prioritization, communication, de-escalation, and personal emotional regulation.
Professors Thomas and Thatcher also try to make the simulation as realistic to in-patient facilities as possible. Grace has worked at the Utah State Hospital for several years, and she said that this simulation is “pretty much as close as you can get to really showing what it's like to be on the unit as a psych nurse”
Although the simulation takes place in a psychiatric setting, the simulation teaches skills that are applicable for nurses in any field. For example, students get to practice using their skills in a high-stress, complicated environment. It also tests their communication skills and their ability to implement TeamSTEPPS™ (Team Strategies and Tools to Enhance Performance and Patient Safety), a universal tool for nurses, as they coordinate patient care. It also helps students understand how to best prioritize patient care; to be aware of all their patients and their needs.
Additionally, this simulation gives the students new appreciation for psychiatric nurses and reduces some of the stigma around patients with mental health challenges. As Grace put it, “the more you humanize the patients, the more that stigma goes away.”
Grace also said that the simulation fosters more understanding of the complications of psychiatric nursing. “So much of psychiatric nursing is about the milieu of the unit, like how patients interact with each other. . . how to de-escalate different situations, how to manage conflicts between the patients, how to also just check in on all your patients and promote a safe unit.”
Catherine echoed a similar sentiment: “Students had to expand their ability to work as a team, and it changed their perspectives on how healthcare workers in the psychiatric realm work with each other.”
While Catherine doesn’t plan to go into psychiatric nursing, she said that her involvement in this research has changed her perception of nursing. “It's giving me some wider perspectives just on how to treat patients better in general, how to be more of a holistic nurse and look more at the person as a whole, rather than just their diagnosis.”
She also said that she has learned that nursing students are more afraid of psychiatric nursing than they need to be. “As long as you're trying to be helpful and supportive, being that support person for them is really the best thing that you can do.”
Catherine said that simulations are an important part of learning, especially for psychiatric nursing, because they “put you in a situation where you can learn without any sort of consequences that are negative that can actually affect people.” She went on to say that simulations give students “the opportunity to try things out, make mistakes and learn from them, so that they can treat psychiatric patients better in the future.”
Research & Conference
Grace and Catherine did all of the data analysis. The data had been collected over the last five years—first qualitative, and then quantitative—as part of a built-in assignment for the psychiatric nursing course. [They switched to quantitative data two years ago when the nursing program standardized their course survey methods.]
There were two takeaways from their research. First, team-oriented, multi-patient simulations can be feasibly implemented. Other colleges and nursing schools can follow the model implemented by BYU College of Nursing and apply it in their own courses to help improve skills and confidence in psychiatric nursing.
Second, interleaving, scaffolding, and repetition all lead to deeper student learning. As Grace and Catherine put it in their presentation, “The culminating simulation provided students with the opportunity to implement all the skills they had practiced in previous simulations. They then were able to reflect on how their perspectives on psychiatric nursing care had changed and areas in their nursing knowledge and skills that need improvement.”
Professors Thatcher and Thomas said that Catherine and Grace both did well on the presentation—not just for undergraduates, but well for conference presenters in general. Several other professionals at the conference approached the professors to compliment Catherine and Grace on their presentation.
Grace and Catherine were the only undergraduate students who presented at the conference. Dr. Thomas said that many people underestimate undergraduate students and their capabilities. Professor Thatcher said that they had other professors approach them and ask how they were able to get undergrads involved in research.
BYU College of Nursing regularly has undergraduate students participate in research. This speaks to not only the talent and ambition of the students, but also to the investment and mentorship of the professors. There is also generous internal funding that allows students to get involved in research.
Professors Thatcher and Thomas said that getting involved in research is valuable because it gets students connected with professional organizations early in their careers. Students learn how to present at conferences. Dr. Thomas, for example, had not presented at a conference until he came to work at BYU.
Catherine said that presenting in front of psychiatric nursing professionals was “definitely intimidating,” especially when she had yet to complete her semester of psychiatric nursing as a student. However, Grace said that once they were presenting, “looking out at everyone, you could tell that they were just all so supportive.”
Putting yourself in an uncomfortable spot is really beneficial to helping you grow... discomfort helps you recognize places that you need to work on, and it provides an opportunity to stretch yourself.
Grace said that her attendance at the conference was a turning point for her. It was during the APNA conference that Catherine applied to the University of Utah for their Doctor of Nursing Practice program, with Professor Thatcher’s encouragement.
Without the support from Professor Thatcher and Professor Thomas, Grace said, “I don't know if I would have pushed myself to apply for a DNP program while I was still in my undergrad. I don't think I would have had that much confidence in myself.”
Mentorship
Catherine still hadn’t gone through her psychiatric rotation in the nursing program when she began participating in the simulation research. However, she’d had friends and siblings work as research assistants and, through them, became curious about the research process. She started reaching out to professors to ask if they had any opportunities. A friend of hers who was working on a separate research project with Professor Thatcher told Catherine that there might be an opportunity to work on a new research project. She reached out, and they began their work.
When Grace got involved with this research, however, she hadn’t been looking for it. She had been speaking with Professor Thatcher about his experience in psychiatric nursing when he invited her to participate in the ongoing research.
I think the more that you get to know your professors, and the more that you interact with them, the more opportunities you'll see come your way. If you sit in the back of the class and you know, never say anything, never reach out, you're not going to find those opportunities, but the more you put yourself out there, the more they'll just fall into place.
Professors Thatcher and Thomas said that one of the best parts of the mentorship was watching Grace and Catherine grow in confidence and realize that they are capable of more than they thought.
Speaking about the mentorship of Professors Thatcher and Thomas, Grace said, “I think they had more confidence in me than I had in myself.” It was that mentorship, as well as the confidence they placed in her, that was pivotal to Grace’s personal growth. “This experience was really empowering for me . . . [it] showed me how much I really am capable of.”
[Professor Thomas] and [Professor Thatcher] were awesome about walking me through the process and then trusting me to do it well. And I appreciated that trust and respect from them with that mentorship. It helped me to grow. I did things that I had never done before.
Catherine said that the professors always made her feel useful, even when she didn’t feel like she knew what she was doing. They were, in her words, “very helpful and complimentary and great mentors.”
She went on to say that both simulations and her research experience have taught her where she needs to grow but also showed her what strengths she has. Her experience has taught her that “it's okay not to know everything, and you can still move forward without being 100% confident with what you're doing.”
Catherine plans to pursue either women’s health or emergency medicine after she graduates from the nursing program.
Grace plans to pursue psychiatric nursing. She will be attending University of Utah for their Doctor of Nursing Practice (DNP) program. Grace will be specializing in psychiatric and mental health nursing, and she’s interested in women’s mental health.