Preparing Nurses to Communicate and Lead: Using Toolkits and Standardized Patient Experiences

With shorter lengths of stay, increased competition for clinical placements, and restrictions that prohibit students from caring for patients deemed to be too unstable, some undergraduate nursing students may not have opportunities to care for individuals with common mental health issues. This challenges nurse educators to find creative learning experiences in which students are able to practice and refine essential clinical skills. One strategy that is gaining popularity is simulation using Standardized Patient Experiences (SPEs). This teaching strategy allows students to use essential mental health nursing and leadership skills in a safe learning environment preparing them to care for “real” patients with mental health needs. Applying theoretical knowledge in a simulated environment, allows students to demonstrate the integration of didactic learning to clinical application (Shian et al 2016). Therapeutic communication skills can be taught in this controlled environment (Webster, 2013). While therapeutic communication is the foundation for interactions with any patient, those with mental health issues require that the nurse have other essential skill sets including the management of hallucinations and delusions, addressing safety including those who are suicidal, setting limits with the manic patient, monitoring patients with addictions for signs of withdrawal, providing patient/family centered care for the individual with dementia, and the assessment of trauma. Additionally, nurses must possess the necessary leadership skills to collaborate with interprofessional teams, advocate for patients and their families, and manage conflict. SPEs provide opportunities for faculty to create structured situations in which students can practice evidence-based care and communication techniques with both patients and the family unit (Webster & DiBartolo, 2014). Such practice allows students to master skills and gain leadership competencies.

Collaboration, conflict management, and advocacy have been identified as essential competencies for professional nurses by the American Nurses Association (2016) and Quality and Safety Education for Nursing (2014). While it has been recognized that new nurses need to demonstrate effective leadership skills, undergraduate nursing students may not have opportunities to apply these competencies in “live” clinical situations. The use of complex scenarios involving standardized patients provides an opportunity to apply leadership principles to realistic patient care experiences (Sharpnack, P., Goliat, L., & Rogers, K. 2013).

To address issues related to difficulty securing appropriate clinical placements and to ensure all nursing students have the opportunity to practice essential communication and leadership skills, a series of toolkits were developed for use in a mental health clinical course in a baccalaureate program. Working in conjunction with representatives from three partner hospitals, ideas for commonly encountered clinical situations were brainstormed. Each toolkit was then designed to reinforce a core skill set and packaged to include learning objectives, pre-simulation activities, video vignettes, feedback rubric, and suggested post-simulation activities. Video vignettes using standardized patients (SP) were created to demonstrate specific skills and were used to prepare students for subsequent live encounters with a different SP. The toolkits also provided strategies aimed at helping students apply core skills. In addition to completing the toolkit assignments, each student participated in four live SPEs. SPEs consisted of 10-15 minute interactions with one or more standardized patients/family member and standardized team member. All encounters were video recorded for later review. Students were debriefed by faculty in a group setting where each student received feedback from faculty and peers. As a post-simulation assignment, students also watched their own video-recordings and completed a self-reflection. Using feedback rubrics, faculty provided formative feedback to students. This feedback consisted of observation of therapeutic communication skills and the assessment and management of symptoms related to schizophrenia, depression, mania, dementia, substance abuse, and trauma. The application of leadership skills related to interprofessional collaboration and conflict management were also evaluated. This innovative approach to mental health nursing education has enabled nursing faculty to provide consistent experiences focusing on development of essential mental health and leadership competencies.