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HealthDecember 08, 2020

Standardized patients assisting first-semester nursing students with assessment skills

By: Shena Williams, MSN, RN
Physical assessment is the most important skill nursing students will have to learn. Every task we perform as nurses first begins with assessment.

First-semester nursing students may find physical assessment overwhelming and challenging for various reasons. There is an abundance of products and books available to help explain assessment, as well as ways to teach students how to perform a physical assessment, however, sometimes these resources may be overwhelming and ineffective. Students have been found to memorize a “script”, of what they should see or hear when performing assessment checkoffs and just going through the motions of the process, instead of performing and noting what they see and/or hear. Manikins are an instrumental part of the simulation experience for nursing students, however, it is obvious that there are limits to manikins. The ability to have real communication, perform true eye, oral, range-of-motion exams and more, are also some of the pros of utilizing real “patients” in place of manikins. Standardized patients (SPs) have been a great way to help the student get real-life experience in a controlled environment. This entry is specially written for schools whose first semester students may not go out into the clinical setting and instead utilize various simulation resources.

Standardized patients give the students opportunities to perform all aspects of the physical assessment including practice communicating with patients during the patients’ health history interview. The students can work on their interviewing skills regarding patient medical history, surgical history and medications as well as their therapeutic communication and patient education. The students have an opportunity to see what it is like to talk to patients from different backgrounds and experience something outside of their classmates or computerized clinical setting.

It is important to ensure that standardized patients are prepared to play the role of a patient to give the students the best clinical opportunity possible. Some of the keys to ensuring a successful standardized patient experience for first-semester nursing students are below.

Recruitment efforts

Recruiting is a major part of the success of a standardized patient program. Flyers are useful however it is the placement of the flyers that have proved to produce results. Placing flyers within the communities in which you wish to recruit from is vital. Churches, older adult centers, YMCA’s, student unions and the school new letter have been the best places to recruit potential participants.

When making a flyer, it is important to keep it brief, yet provide enough information to the potential participant. It should include a flashy heading announcing that you are looking for participants/volunteers for the Standardized Patient Program. It’s important to make note of what the program is as well as the dates and times the program is running, and if there is an incentive for the participants’ time. Including a contact person name, phone number, and email so that they know how to sign up and whom to contact for additional information is vital.

Process

Medical schools often use standardized patients over long periods of time, sometimes adding them to the schools’ payroll as an “employee”. Nursing school’s standardized patients differ in that these patients are often only needed for one to two hours for the simulation activity. Unlike medical students, the first-semester nursing students experience will be geared toward mastering physical assessments and communication, instead of exploring all disease processes and diagnosing.

Having two students to each standardized patient, one to perform the assessment and the second to ask questions from the health history document, helps to keep the assessment flowing and the students on track. The students are briefed before going to the participants’ bedside of why the participant is there and how the process should flow. They are reminded of vital supplies, hand hygiene and given a brief report similar to the hospital staff nurses. While performing the assessments instructors are “flies on the wall.”

The debriefing process consists first of the student terminating the relationship with the “patient” and providing them with a paper that contains a survey and grading tool. This is a vital piece to provide feedback to the students as well as for the program as a whole in order to provide any improvements that may be needed. Once the patients leave, instructors can gauge how the student felt during the assessment, give opportunities to critically think about what they would expect to do for the client if they were admitted to the hospital setting, and to discuss what to do in the future. Debriefing is often one of the most important parts of the process for the students. Many have expressed their excitement and how they “love the hands-on”, “feel like a nurse”, “actually heard what I read about.” Providing positive reinforcement during this time has proven to be an effective measure.

Tips for a successful standardized patient program

  1. Setting the stage – When choosing and recruiting your standardized patient, make sure that they fully understand the expectations. Standardized patients should be able to remain in character for the duration of the assessment. It is often ideal to have the patient play a role of a disease process they currently suffer from, as they will be more familiar. If they are healthy, it is highly suggested that the signs and symptoms they are to exhibit be explained to them ahead of time so that they can adequately prepare. Remember you want this experience to feel “real” to the student.
  2. Recruitment efforts – Recruiting can take place in many forms, however catchy flyers, briefly explaining the process have been most effective. Placing flyers in high traffic area: Church, Gyms, Service Stations and Student Unions have been the most effective way to gain participants. Often standardized patients also recruit others, so be sure to mention if they can refer, family, friends or relatives.
  3. Set limits – Faculty, nursing students and nursing school administrators should not be used whenever possible. The level of intimidation can be increased when using faculty or administrators as patients. The students are already entering a “new” situation that often makes them nervous, seeing a former or future instructor could be very intimidating, as they may think they are being judged. Having other nursing students as patients could be successful, however, it is better to have participants that the students performing the assessment do not know. Not knowing the participant gives the students a more authentic experience.
  4. Incentives – While many participants have stated in the past that they enjoy helping the students, one major factor that motivates them to come back is a small incentive. Often gift cards or small payments, dependent upon the program’s rules, worked as great incentives to recruit and retain participants. If offering gift cards, it’s a great idea to mention this on the flyer, as more people are inclined to get more information on the program. It is also essential that when discussing the program with the patient and prior to them receiving their gift card, that someone explains that it cannot be replaced if lost and exactly how much is on the card.
  5. Lightening the mood – As an instructor, it’s imperative to make sure your students and participants are comfortable throughout the process. The use of standardized patients should not be an intimidating act, but an education and, dare I say, fun simulation. As the instructor, and as a nurse, you have the ability to relate to clients and provide encouragement to the students. Talking to the participants ahead of time, letting them know what to expect and helping them to understand what level the students are on, as well as thanking them for creating an opportunity for the students, often shows them how vital they are and motivates them to perform to the best of their ability. This also helps to relax the student because the participants are often more welcoming instead of being critical.

Standardized Patients can be a great resource for clinical and simulation for first-semester nursing students. Live patients can provide better learning opportunities than manikins, in that they can provide thorough communication as well as provide assessment features that the manikins cannot. There are many things to consider when starting a program, including recruitment efforts, limit setting, incentives, and roles of the instructor in overseeing the program.

Shena Williams, MSN, RN
Expert Insights Contributor for Wolters Kluwer, Nursing Education
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