Nurse educators with specialized education in simulation and debriefing, traditionally use standardized patients for teaching communication, empathy, and care skills to graduate and undergraduate students. Standardized patients are lay people or professional actors trained to portray specific illness or care situations that may be experienced by future nurses. New educational innovations include the use of nurse educators and standardized patients (SPs) to train future elementary and secondary school teachers for parent-teacher conferences using simulated parent teacher conferences. A second emerging innovation is the use of nurse educators and SPs to prepare business executives for difficult conversations with peers and employees.
Communication -- the human connection -- is the key to personal and career success.
- Paul Meyer
Professional and empathetic communication is a major life skill required for many disciplines, including nursing. Miscommunication between nurses and their patients can lead to poor patient outcomes resulting in a prolonged hospital stay, readmission to the hospital, injury, or death. A major focus of undergraduate nursing education is teaching students the art of listening to patients and communicating effectively with their patients.
Standardized patients (SPs) are people trained to portray various illnesses and patient care situations for both undergraduate and graduate nursing students. The focus of these interactions is for the SPs to provide practice and feedback to students, before the students interact with real patients. Students practice communicating without using medical jargon that patients might not understand, picking up on unspoken patient questions and concerns, body positioning for effective communication1, and practice comforting behaviors such as therapeutic touch, and various empathetic responses.
Standardized patients have been commonly used in medical schools since the mid-1960s to provide realistic but simulated patient encounters for students to practice communication and diagnostic skills. SPs provide the ability to standardize a patient encounter for multiple students. Research indicates that practice with live actors prior to real patients decreases learner anxiety and increases the quality of communication1 when a student interacts with a “real patient.”
Standardized patients may be lay people but are often also aspiring or professional actors who supplement their income by portraying patients. Many SPs engage in this work because of the satisfaction they feel in making a contribution to improving patient care and safety through developing practical and communication skills of healthcare providers. In preparation for a typical educational encounter, an SP receives a script with a character description and a health history, coaching, and training in providing feedback to students, as they prepare for their roles. The use of a SP allows an educator to provide a standardized patient care experience for a number of students, which is not possible in the traditional clinical environment.
Students prepare for simulation in the on-campus simulation lab by reviewing learning objectives and skills required within a scenario. They receive a pre-briefing about the patient they will care for and about what they are expected to accomplish in the patient care scenario, which lasts about 10-20 minutes. The faculty, student, and SP typically meet, along with other students in the class, for a formal debriefing session immediately after the completion of the scenario. This typically lasts about twice as long as the actual simulation. Students can ask SPs about how their words, actions, and demeanor appeared to the “patient,” and what the student might do, to improve his/her skills and bedside manner.
Students’ first encounters with a “patient” are often SPs, in foundational nursing courses. Objectives for these encounters may involve taking vital signs and talking with the patient to discover something “new and not necessarily on the chart,” about the patient. If students are skilled in their communication, they may find out things like the SP loves the Steelers and has a dog named Skip.
Students may experience SPs portraying acute untreated major psychiatric diagnoses such as depression, mania, and schizophrenia, during a mental health course. Acute mental illness is rarely experienced by students in the clinical setting thus, these encounters help prepare students, in a safe environment, for what they might encounter, in the real world setting.
Standardized patient simulations not only provide students with realistic patient care experiences; the scenarios are easily adjusted to reflect changing clinical, and program objectives or goals. Simulations occasionally reveal program content gaps. Missing content or skills are added to future simulations to provide the needed content. Safer patient care is integrated into the students’ mental models as they practice nursing care under the eye of experienced nurse instructor facilitators. Best practices in nursing care and communication are learned through a combination of quality feedback from the SPs and skilled debriefing by simulation instructors. Students are encouraged to thoughtfully reflect on their actions and patient communication in the simulation room. Any practice gaps or errors are caught and corrected in the moment.
Standardized patients are also trained to be standardized family members for students in the School of Education. In these scenarios, students preparing to be teachers practice writing and presenting student-specific Individual Education Plans (IEP). The SPs receive scripts preparing them to discuss their “children” and information about their fictional family background, current and past home situation, and life experiences. They provide feedback for students about how their verbal and non-verbal communication and questions were perceived by the “parents.” This practice before the first real experience allows students to try various “scripts” for conducting IEP presentations to parents or guardians of children with learning or behavioral challenges and to receive feedback on their approach, just as the nursing students do.
The RMU Regional Research and Innovation in Simulation Education (RISE) Center is one of the first health care-based simulation programs to begin training business executives. RISE Center faculty recently used SPs to portray “standardized” workers and executives, to provide teamwork and communication opportunities for mid-level executives during a one-day corporate simulation training experience. The process for the preparation of the SPs remained the same; scripts were developed around the top 10 problems in business teamwork and communications. Scenarios were written and scripts were prepared for the actors. The corporate managers and executives were oriented to the simulation and debriefing process. SPs participated in the debriefing process providing feedback to the executives about their experiences as the employee. The experience was so well received that more simulation opportunities are being built into the executive training program.
Effective communication is a major life skill required by multiple professions. The RMU Regional Innovation in Simulation Education (RISE) Center is accredited by the Society for Simulation in Healthcare and staffed with credentialed health simulation educators (CHSEs). Simulation centers using SPs are well positioned to increase their interdisciplinary and social impact by capitalizing on their communication expertise to providing meaningful interactive educational opportunities to other disciplines. Regardless of the discipline, outcomes are consistent. Learners report an appreciation of the human interaction, a decrease in stress and an increase in their ability to handle difficult conversations, demonstrate increased empathy and overall improved communication skills.
1 Sarikoc, Gamze, Celale Tangul Ozcan, and Melih Elcin. 2017. “The impact of using standardized patients in psychiatric cases on the levels of motivation and perceived learning of the nursing students. Nurse Education Today, 51:15-22. Doi: 10.1016/j.nedt.2017.01.001
Suzan Kardong-Edgren PhD, RN, ANEF, CHSE, FSSH, FAAN is professor at Robert Morris University and Director of the RISE Center. She is internationally recognized for her work in simulation research and education.
Jan Barber, MSN, RN CHSE, manages the standardized patient program at Robert Morris University School of Nursing and Health Sciences, Moon Township, Pennsylvania. She received her BSN from the University of Pittsburgh School of Nursing and her MSN from LaRoche College.
Val Howard EdD, MSN, RN is Dean of the School of Nursing and Health Sciences at Robert Morris University. She is a past-president of the International Nursing Association for Clinical Simulation and Learning and founding Director of the RISE Center.