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Background: Research shows that psychiatric staff lack clinical confidence working with voice hearers. Simulation training is promising but staff input is limited.
Aim: The present study aimed to qualitatively investigate ward staff experience of working with voice hearers and their perspectives on simulation training. Method: Multidisciplinary psychiatric ward staff participated in semi-structured interviews on their experience of working with voice hearers and their views and recommendations on simulation training. Participants included seven nurses, five healthcare assistants, and three activities co-ordinators.
Results: Following thematic analysis, staff experience themes included Negative impact on therapeutic relationship, Clinical experience improves understanding of voice hearing, Empathy for voice hearers, Challenges of managing risk, Lack of subjective understanding of voice hearing, Limited training for working with voice hearers and Lack of clinical confidence. Views on simulation training themes included Potential to improve subjective understanding, Anxieties about emotional responses, Keenness to participate and Potential to improve clinical confidence. Simulation training recommendation themes included Incorporate practical, skills-based elements, Invite all mental health staff to participate, and Use genuine voice hearer experiences.
Conclusion: Lack of subjective understanding and clinical confidence was linked to training limitations, but skills-based simulation training was endorsed as a valuable method to improve staff understanding, confidence, and quality of care.
Keywords: inpatient services; auditory hallucinations; mental health; psychosis; qualitative research; simulation training
Introduction
Voice hearing is a complex phenomenon, which is present across a variety of cultural and historical contexts (Longden 2017). The Hearing Voices Movement has encouraged change in the ways voice hearing is conceptualised and understood, highlighting that the experience is subjectively real and meaningful (Longden 2017; Armstrong et al. 2021). A cultural shift has occurred towards understanding voice hearing as common and existing on a spectrum of experience (Armstrong et al. 2021) and it is estimated that 10% of people have experienced voice hearing at some point in their lives, including in childhood (Fisher et al. 2013; Maijer et al. 2018).
Differences in frequency, intensity and distress associated with hearing voices predict who will access mental health services (McMullan et al. 2018). Hearing voices is a common experience among patients on psychiatric wards (Csipke et al. 2014; Jacobsen et al. 2016). Distress caused by voices can lead to anxiety, fear, withdrawal and challenging behaviours from inpatients,...