Mental Rehearsal Strategy for Stress Management and Performance in Simulations

Jeanette Ignacio*, Albert Scherpbier, Diana Dolmans, Jan-Joost Rethans, Sok Ying Liaw

*Corresponding author for this work

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Background: A mental rehearsal (MR) strategy using standardized patients was implemented for third-year nursing students in a simulation training on clinical deterioration. The study aimed to evaluate its efficacy, by comparing with a conventional approach using a mnemonic strategy with mannequin simulation, for improving the nursing students' performance and reducing their stress level in patient deterioration management. The study also explored the students' perspectives of using MR during their clinical practice.

Method: Amixed methods design was used. Thirty-two third-year nursing students participated in a randomized posttest. They were assigned to either the MR group or mnemonic group. Performance was observed and measured using simulation-based assessment. StraiteTrait Anxiety Inventory, heart rate, systolic blood pressure, and skin temperature were used as stress measures. Twenty-one students participated in individual interviews after a nine-week clinical posting.

Results: Performance between the MR group and the mnemonic group (p =.105) did not differ. The state (p =.524) and trait (p =.516) anxiety inventory, systolic blood pressure (p =.890), heart rate (p =.692), and skin temperature (p =.521) did not differ between the two groups. Three themes were generated from the application of MR on students' clinical practice: being mentally and emotionally prepared, recalling and visualizing the steps to be taken, and enhancing actual clinical practice.

Conclusions: Both MR and the mnemonic strategies had similar effects on performance and stress during patient deterioration management. However, the interviews suggested that MR still benefits learning and has value in health professions' training.

Original languageEnglish
Pages (from-to)295-302
Number of pages8
JournalClinical Simulation in Nursing
Issue number7
Publication statusPublished - Jul 2017


  • nursing education
  • psychological stress
  • simulation training
  • anxiety
  • mental rehearsal
  • performance

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