Standardized Patient Simulation for Evidenced-Based Practice with First Semester BSN Student

Purpose: The best strategy of incorporating evidenced based practice (EBP) concepts into first semester undergraduate nursing curricula is not well established. Since new nurse graduates may have a 2 year delay in translating research to practice, the purpose of this project is to illustrate how first semester BSN students use initial EBP skills during an interaction with standardized patients (SPs) in a simulation lab. Safe communication is key to reforming how evidence is formulated and used to enrich the value and effectiveness of health care. Improvement in patient safety, patient satisfaction, and the value of health care all depend on the improvement in communication. Effective communication skills are an essential component in providing safe patient care.  This experience allowed students to interact with patients in a safe environment prior to going into an actual clinical setting. 

Design: Descriptive, mixed methods design

Setting:  School of nursing clinical performance lab in suburban university

Participants/Subjects: All nursing students (n=83) in the first fundamentals medical/surgical course of the BSN program participated in a simulation experience with SPs as part of a clinical skills lab learning experience.

Methods: Students were provided written instructions, objectives, and the rotation matrix 1week before the lab. The SPs were cognitively and physically prepared with extremely realistic presentation of conditions using moulage. Every 15 minutes, students rotated among four SP vignettes (shingles, decubitus, colostomy, cellulitis). Students conducted physical assessments, developed nursing diagnoses, and considered appropriate interventions. After rotating through vignettes, students met for 30 minutes to debrief with faculty. A Likert style tool evaluating student satisfaction, critical thinking, course application and lab organization plus a comment section for open remarks about communication, critical thinking and individualized care was completed at session end.

Outcomes: The Likert scale included a range of strongly disagree to strongly agree regarding several criteria. Of those who chose agree to strongly agree, 84% were satisfied with the experience, 88% “used critical thinking rather than memorization”, 89% said project “helped me apply coursework to real-life” and 91% stated “session coincided with other parts of the course”. Of those who chose disagree to strongly disagree, only 16% stated “lab content was organized”. Student comments were reviewed using content analysis; the following themes found: “Communicating like a nurse”, “Thinking like a nurse”, “Confidence in getting to know the patient”, and “Decreased anxiety”.

Implications: First semester BSN students can apply initial EBP skills in simulated experiences with SPs. Educators should provide learning experiences promoting these skills early in the curriculum. Future research can determine 1) the relationship of student reflective journaling on the internalization of EBP knowledge and practice and 2) the best distribution of EBP communication, critical thinking, and patient centered care attributes throughout the curriculum.