Unfolding Case Study Using Human Patient Simulation in an Advanced Practice Nursing Program

INTRODUCTION:  The use of human patient simulation (HPS) in nursing education has expanded in recent years, in part due to the increasing challenges educators face in finding sufficient clinical placement for students.  Limitations imposed by clinical entities deemed appropriate for precepted experiences for students in advanced practice nursing programs have increased.  HPS using standardized patients offers a viable adjunct to clinical experiences in which advanced practice nursing students can develop and be evaluated in terms of their clinical knowledge, skills, and attitudes.  HPS has been shown to be an effective alternative to traditional clinical experiences for students in an undergraduate nursing program.  Literature, however, is limited on the use of HPS for the purpose of educating and evaluating advanced practice nursing students.

PURPOSE:  The purpose of this presentation is to describe the development and implementation of a HPS learning experience in an advanced practice nursing program using an unfolding case study approach with standardized patients. 

METHODS:  Advanced practice nursing students in their final semester of a family nurse practitioner program at Mercer University in Georgia participated in a clinical experience conducted in the school's simulation laboratory as part of a clinical practicum course.  A faculty developed unfolding case study consisting of three distinct, sequential patient scenarios served as the basis for the experience.  Standardized patients recruited for the scenarios were provided background information and scripts to familiarize them with the patient presentation of joint pain, initially, and subsequent abdominal pain, and to coach them in terms of appropriate actions and responses to student questions and examination during the progressive scenarios.  Program faculty served as observers and evaluators of student performance throughout the experience.  Students were presented with the standardized patient for evaluation in a simulated outpatient setting.  Consistent with an unfolding case study, each student engaged in three separate, supposedly time-lapsed, sequential encounters with the standardized patient over a three-hour time period.  Patient charts and supporting data pertinent to each encounter were reviewed by the student prior to and during each visit.  A health history and physical assessment were completed at each patient encounter, concluding with documentation of findings and a comprehensive treatment plan.  Student assessment of evolving patient issues and evaluation of previous assessment findings and treatment plans served as the foci of faculty observation.  Evaluation of student performance in the areas of communication, physical assessment, and documentation skills also was conducted.  Debriefing, faculty feedback, and student self-evaluation of performance followed completion of the sequence of scenarios.  In addition, students were asked to complete a written evaluation of the experience using an evaluation form designed by faculty. 

RESULTS:  Positive feedback from students and faculty supported the value of the simulated experience in reinforcing student clinical knowledge and skills.  Written evaluation from students also supported advancement of knowledge and, along with oral feedback from faculty, identified gaps in teaching and learning which served as a valuable outcome of the simulated clinical experience.      

CONCLUSIONS:  HPS using standardized patients and an unfolding case study approach may be a viable adjunct to traditional precepted clinical experiences for reinforcing knowledge and skills and assessing student learning in an advanced practice nursing program.  In addition, identification of teaching and learning needs of students related to clinical knowledge, skills, and attitudes may be derived from these experiences.  Debriefing, feedback, and student self-evaluation are important components of simulated learning experiences.  Implications for educational and clinical practice and research are evident.