Making Simulation Come Alive: Standardized Patients in Undergraduate Nursing Education

Abstract

Simulation is one solution for overcoming the limitations of traditional clinical nursing education (Tanner, 2006). Variable patient census, the uncertainty that students will encounter essential learning experiences, and the inefficient use of time limit the effectiveness of current clinical settings (Tanner). In addition to providing essential experiences and encounters with specific populations, simulations engage student learning independent of faculty and can be designed to increase the student's level of responsibility in a scenario, something that may not be possible in a traditional clinical setting. Simulations also allow faculty to center their attention on the student, rather than focus on protecting the patient from possible student error. While simulation is a burgeoning strategy to augment and complement clinical practice education, full implementation requires a broader scope than dependence on manikin-based simulation alone. This article discusses the elements involved in designing simulation cases for use with standardized patients (SPs) and describes how to integrate formative learning activities with SPs into an undergraduate curriculum. The Association of Standardized Patient Educators (2010) defines standardized patients as individuals ... trained to portray a patient with a specific condition in a realistic, standardized and repeatable way (where portrayal/presentation varies based only on learner performance).... [SPs] can be used for teaching and assessment of learners, including but not limited to history/consultation, physical examination and other clinical skills in simulated clinical environments.... [They] can also be used to give feedback and evaluate student performance (p. 9). In medical and nursing programs that use SPs, there is often an emphasis on using this educational strategy as a summative assessment to measure clinical competency. The most common content areas for SP use are communication and clinical and physical examination skills (May, Park, & Lee, 2009). Advantages of using SPs for formative learning include the opportunity for reflection, the ability to observe the student's clinical abilities performed independently, and the realism of the practice case (Robinson-Smith, Bradley, & Meakim, 2009). DESIGNING SIMULATIONS FOR USE WITH SPS Scenario design with SPs begins like any other simulation--with a clear statement of the goals for the learning activity. When the focus for learning is on the patient's psychosocial-emotional responses to the situation and when body language and physical movement are key components of the learning situation, then SPs are the better choice over manikins. Simulation and content faculty should first develop learning objectives and prioritize learning concepts for students, that is, decide which enduring understandings are most desirable (Wiggins & McTighe, 2005), then outline the scenario. These elements become the basis for developing the character(s) and dialogue. Essential aspects of the character need to be identified, such as age (date of birth), family history, and past medical history, so the SP understands what has brought the character to this particular point in time and can therefore bring consistency to the conversation. Then, appropriate symptoms are identified, along with behaviors that support the symptom presentation and dialogue based on the questions expected from a nurse in the developing situation. A content expert aids in the development of realistic dialogue, behaviors consistent with the disease, and typical patient responses to common nursing actions (Bosek, Li, & Hicks, 2007). When the situation is more complex, nursing students can take on the roles of nurses, family, and friends. In our simulation on schizophrenia, described in further detail below, an SP, an undergraduate theater major, plays the role of Ryan, the diem, and nursing students take on the roles of nurse and Ryan's friend Dan. …