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ROADMAP TITLE
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| Welcoming Suicidal Communication in the Virtual Environment |
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GENERAL OBJECTIVE
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| - Welcoming suicidal communication in the virtual environment, encouraging initial support behaviors. |
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TARGET AUDIENCE OF THE ROADMAP (ROADMAP PARTICIPANTS)
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| Undergraduate health students (who have taken subjects related to mental health/psychiatry) and health professionals. |
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NUMBER OF PEOPLE NEEDED TO DEVELOP THE ROADMAP
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- Two simulation coordinators (responsible for developing the simulation);
- One participant (target audience) who will take part in the simulated activity;
- A role-player (who will simulate the person behind the Virtual Social Network);
- Observers (other participants who exceed the number of participants provided for in the roadmap).
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PHYSICAL RESOURCES AND MATERIALS
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- Teaching Laboratory or Classroom that simulates an environment/space for using a computer or visual resource:
This roadmap takes place through an interactive simulation in the online environment, with the use of any virtual tool that performs audio, video, and text sharing (adaptive). It therefore requires the use of a device (cell phone or computer) that can be transmitted or projected onto (television or projector). Materials built for the Virtual Social Network (Supplementary Material 1).
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MATERIALS FOR PRE-READING BY PARTICIPANTS AND OBSERVERS (PROVIDED BY THE ROADMAP COORDINATORS VIA E-MAIL FOR PRE-READING BY PARTICIPANTS AND OBSERVERS)
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- These materials will be made available by the roadmap coordinators, via e-mail, for prior reading/viewing by all the participants involved:
- Educational video on: “Safe Communication about Suicidal Behavior in Virtual Environments”, available at: https://www.youtube.com/watch?v=XfYW1d5q3K4&t=4s
- Booklet “How to help someone at risk of suicide?” https://inspiracao-leps.com.br/cartilhas-e-e-books/como-ajudar-alguem-em-risco-de-suicidio/
- Educational video: “Safety and Mental Health Tips on the Internet” - https://inspiracao-leps.com.br/videos/dicas-de-seguranca-e-saude-mental-na-internet/
- Booklet “Mental Health in Times of Pandemic”. https://inspiracao-leps.com.br/cartilhas-e-e-books/dicas-de-uso-seguro-na-internet/
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ESTIMATED DURATION FOR EACH STAGE OF THE ROADMAP
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1. Prebriefing (15 minutes);
2. Simulation (20 minutes);
3. Debriefing (40 minutes).
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PREBRIEFING (INFORMATION ABOUT THE CONTRACTS AND THE CONDUCT OF THE SIMULATION)
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1. Present the environment with the computer (or digital resource) to the participants in the roadmap before the activity begins (Supplementary Material).
2. Present the teaching and learning method, emphasizing the collaborative and non-evaluation nature of the process. Explain that it involves an external member (simulated patient) who will be attended to virtually by a student or health professional, while the rest of the group (observers) watch the scene attentively. During the simulation, it is not recommended that the person carrying out the care be directed toward the observers, and the facilitators will not intervene in the scene. The observers play an active role in the observation, as they collaborate in the discussion during the debriefing. Hence the importance of participating in the discussion after the simulation.
3. Discuss the contracts on emotional and ethical safety with the participants: confidentiality, anonymity, respect, and the possibility of suspending the activity in the event of emotional discomfort. In this case, it’s recommended that the student chooses whether to be welcomed individually or to share their feelings in a group. If the option is individual, it is also recommended that the group of students and/or professionals receive emotional support and ask questions.
4. This simulated roadmap includes the presentation of Julia’s fictitious profile (Supplementary Material). This roadmap takes place through an interactive simulation in the online environment, using a virtual tool that shares audio, video, and text (adaptable).
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PREBRIEFING (BASIC GUIDELINES FOR THE SIMULATED CASE - CAN BE READ OUT AND NO INFORMATION SHOULD BE OMITTED)
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This will be a simulation with a director, carried out using multimedia resources in a virtual tool, which shares audio, video, and text (the virtual tool can be adapted).
You’re online in your virtual social network. For some time you have noticed that a “follower” (acquaintance) on the social network has been following and posting content with a depressive, self-deprecating characteristic, expressing the feeling of loss of meaning, lack of reasons to live, feeling left out, lonely, and empty. In the items liked on this individual’s social network, there is content about non-suicidal self-injury and suicide. In the stories of the virtual social network, this “follower” has posted videos of risky behavior, such as drinking and driving at high speed.
This person starts a conversation with you on their social network, privately (because they know you’re in the health field), in order to talk to someone who is in this field.
In this first moment, you will have approximately 30 minutes to talk.
The simulation lab will not be interfered with by people outside the activity and will be terminated by the simulation coordinators when one of the users goes offline or when the time allotted for the simulation has elapsed.
Question for participants and observers: Do you have any questions about the guidelines and preparation presented?
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INSTRUCTIONS FOR THE SIMULATED PATIENT (PREPARATION SHOULD BE CARRIED OUT IN THE DAYS LEADING UP TO THE SIMULATION)
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You will be Júlia, 24 years old, single, living in a sorority with three other girls. Júlia has been studying for the university entrance exams for three years to try to get into medical school. Júlia’s family lives in another state and, due to the distance, they are only able to visit her twice a year. During the simulation, you will have to address some of the feelings, sensations, and difficulties you have experienced, presented in the form of clues, such as:
Clues that you will necessarily address in the case:
• Unbearable pain and sadness;
• Loneliness and misunderstanding: “If loneliness could kill, I wouldn’t be here anymore”; “I’m surrounded by people, and at the same time, I feel very alone”.
• Discouragement: “I get home and go straight to bed, if I could I’d stay in bed all day, I don’t feel like going to the course”.
• Feeling of pressure: “My mother said that this is my last year here. That if I don’t pass this year, I’ll go back home because she feels she’s”throwing money away”.
• Guilt: “I don’t know what’s going on because, as my mother says, I have everything and I still feel like this. So many people are worse off [...]”, “People comment on my photos saying ‘so beautiful, you shouldn’t be posting these things’, I feel worse”.
• Feeling devalued: “Nobody sees how much I studied, they just demand it from me [...]. Little do they know that I struggle through my days [...] I can’t make myself feel better”
• Questions related to death: “Maybe it would be better for everyone if I weren’t around. One less burden for my parents”; “everything would be different if I ceased to exist [...]”.
• Virtual social networking and ambiguity: “I’ve started participating in some groups here on the Internet, but there are days when I feel worse when I see the posts”; “I’ve also made friends who understand what I’m going through, who I feel I can open up to [...]”.
• Substance use and abuse: “Sometimes I think I’ll only be able to turn my head off if I’m drinking”, “some days I’m drinking, I get in the car and drive around aimlessly, trying to feel something”.
• Previous suicide attempt: “I’ve tried to kill myself, but I’m no good at it, I didn’t succeed”.
Clues that you will address if you have the chance/opportunity
• Shame: “Everyone’s life is moving forward and mine is always in the same state [...]”.
• Sense of loss of meaning: “I’ve always loved reading and drawing, but lately I don’t want to do anything”.
• Impaired self-care: “Some days I don’t even get out of bed to eat”, “I don’t see the point in eating anymore”.
Note: the simulated patient needs to be familiar with the “Structured Objective Clinical Examination” (item below) before the role-play, so that they can program their clues according to what is expected in the roadmap.
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OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE )
FOR EACH ITEM BELOW, ASSESS WHETHER THE ACTION TAKEN WAS CARRIED OUT PROPERLY, USING THE ANSWER OPTIONS YES, PARTIALLY OR NO.
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Items assessed
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Assessment
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| OSCE 1: Enabling people to speak and listen, recognizing that they can express their feelings, experiences, and needs at their own pace and time. |
( ) yes
( ) in part
( ) no |
| OSCE 2: Develop safe communication in the virtual environment, promoting recommended communication (Examples: seeking help, social and professional support, among others). |
( ) yes
( ) in part
( ) no |
| OSCE 3: Promote non-judgmental communication, avoiding telling the person what they need to do, say, or how they should feel. |
( ) yes
( ) in part
( ) no |
| OSCE 4: Encourage the person to express their need for help and how they want to be helped, encouraging communication. |
( ) yes
( ) in part
( ) no |
| OSCE 5: Identify the “Stages of Change” for healthy online behavior, guiding preventive online content. |
( ) yes
( ) in part
( ) no |
| OSCE 6: Guide the person to seek out places and people who make them feel safe and protected, strengthening these supportive relationships in order to avoid isolation (e.g. family, friends, groups, support groups, professional help, among others). |
( ) yes
( ) in part
( ) no |
| OSCE 7: Identify warning signs by analyzing posts on social networks or conversations with Júlia. |
( ) yes
( ) in part
( ) no |
| OSCE 8: Encourage the person to practice self-care, stimulating their well-being with satisfying relationships, positive emotions, and a sense of hope. |
( ) yes
( ) in part
( ) no |
| OSCE 9: Valuing the individual’s potential, selecting positive aspects and stimulating protective factors. |
( ) yes
( ) in part
( ) no |
| OSCE 10: Promote safety by guiding the person to avoid making impactful or drastic decisions while they are feeling this way. |
( ) yes
( ) in part
( ) no |
DEBRIEFING BASED ON “THE DIAMOND” MODEL
(STAGE DEVELOPED AFTER THE ROADMAP THROUGH THREE CONSECUTIVE PHASES)
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Descriptive phase (to show how the case turned out, without judging the participants’ performance during the simulation).
How did you feel during the initial welcoming of Júlia? |
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Analytical Phase (Evidence of non-technical skills involved in the simulation that were important to the participants)
What positive actions were taken during the initial welcome for Júlia?
What would you do differently during the initial welcome for Júlia? (Question addressed to the participants in the roadmap).
How do you consider your performance in group work during the initial welcome for Júlia? (Question posed to the participants in the roadmap).
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Applicative phase (Evidence of how the participants will be able to apply the knowledge in their clinical practice).
What will they be able to take from this experience in the simulation of receiving Suicidal Communication in the Virtual Environment into their professional practice?
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