Use of Standardized Patients to Enhance Health Assessment Skills of Undergraduate Nursing Students

Using Standardized Patients to Enhance Health Assessment Competencies for Undergraduate Nursing
Students

Background:
Standardized Patients (SPs) have been used in medical education since the 1960’s however the concept of using SP’s in the field of nursing education is a recent concept. The undergraduate nursing health assessment course has been taught in the same traditional manner for decades.  In order to learn physical assessment skills, students are often asked to take part in peer physical examinations (PPEs), where students practice and validate assessments on one another.  Although students may tolerate PPEs, this methodology often promotes simple memorization over critical thinking. Additional drawbacks with PPE’s are some students may feel uncomfortable being examined by their peers, lack of opportunity to assess abnormal assessment findings, and potential exposure of student's personal medical conditions through PPS. An alternative to using PPEs for testing purposes is the use of SPs to portray patients in a health assessment course. Use of SPs can decrease student’s anxiety, increase critical thinking, and also enhance learning through immediate feedback from the SPs. The purpose of our study was to evaluate student’s satisfaction with assessing SPs versus their peers during the final physical assessment return demonstration.

Methods
Our health assessment course was revised in an effort to find innovative teaching modalities that would enhance critical thinking and decrease memorization of assessment skills. A major revision was the use of SPs for the final physical assessment return demonstration. Our instructional team incorporated the use of SPs and interactive case studies into the course and SPs were hired for the final head-to-toe return demonstration. For the final return demonstration, we developed 3 patient scenarios that all contained one abnormal physical assessment finding that students had to identify during the exam. The return demonstration started with students reading a brief summary of the patient’s reason for admission. Students were then given 15 minutes to obtain a brief history on the reason for admission and then perform a basic bedside nursing head-to-toe assessment. Students were required to properly demonstrate all physical assessment techniques outlined on the form and correctly verbalize their findings in order to pass the final return demonstration. A survey was developed by the principal investigator to collect information on student preparation, comfort, and confidence in performing their final head-to-toe return demonstration on student partners or standardized patients.  The survey was reviewed by two experts in nursing education, simulation, and health assessment for content validity, and the survey was finalized based on their feedback. The survey included the collection of demographic and cohort information and 13 Likert-type questions and 5 open-ended response questions related to the return demonstration experience. Two undergraduate cohorts were given the survey. Cohort 1 consisted of students who performed PPE's for their final assessment during the fall 2012 semester. Cohort 2 consisted of students who completed their final return demonstration on a SP during the spring 2013 semester. In this mixed method, descriptive, IRB-approved study, a convenience sample of 117 students (70 in the first cohort; 47 in the second cohort) participated. 

Findings

The findings showed that students in the cohort 2 were more nervous and less comfortable with the use of SP’s than cohort 1 (p < 0.05). However, the second cohort felt that their final demonstration required more critical thinking and less memorization than cohort 1 (p < 0.05). Cohort 1 reported that they did not like performing their assessment on their partner, felt the final demonstration required less critical thinking and more memorization, the final exam was not a realistic representation of the clinical experience, and they were nervous performing in front of their partner. Cohort 2 stated felt their final exam was more realistic, feedback from the SP’s was valuable, and they felt more comfortable examining an SP versus their partner.

Conclusion

Nurse educators continually look for ways to improve teaching modalities and ensure we are preparing students to provide safe and competent patient care.  Research has shown that the use of SPs in nursing education enhances communication skills, increases student self-confidence, encourages critical thinking, and assists students in overcoming nervousness and anxiety.  Incorporating the use of SPs in the undergraduate nursing curriculum can improve students’ assessment skills, which can then translate to clinical practice.  Focusing on the essential assessment skills needed for the new graduate and incorporating case-based scenarios using SPs has shown to increase students’ critical thinking skills and provide a more realistic clinical experience.  Additional research should be conducted to examine the cost versus benefit of the use of SPs in the undergraduate nursing program.