Increasing Students' Self-Confidence in Patient Interaction through Standardized Patient Simulations

Background & Purpose:  Self-confidence is an important factor for developing clinical competence. First semester nursing students report anxiety and the lack of confidence to approach patients in the clinical area for an assessment interview and subsequent provision of care.  Standardized patient simulations provide a venue for students to practice their communication skills and receive feedback from the “patient”.  The purpose of this article is to describe the result of standardized simulation exercises and its impact on students’ self-confidence.

Methods:  A quasi-experimental pre-test/post-test design was used to investigate the impact of standardized patient simulations on students' self-confidence.  A convenient sample of first semester nursing students completed a pretest self-confidence questionnaire before exposure to the standardized patient.  The Confidence Questionnaire is a 10-item Likert Scale of 1 to 5, strongly disagree, disagree, neutral, agree and strongly agree.  Students were given two exposures with patient debriefing after each exposure.  Students completed a posttest self-confidence questionnaire after the second exposure.  The data collection span 5 semesters: Summer 2012, Fall 2012, Spring 2013, Fall 2013 and Spring 2014.  The participants were first semester nursing students in the Psychiatric Mental Health Nursing course.  A paired sample t-test was performed to test the differences between the pre- and post-test self-confidence scores with a Bonferroni corrections for multiple testing applied by dividing the alpha value of 5% by 2, yielding a significance level of .025. The 2-dependent samples Cohen’s d were calculated and reported for the effect size of the total pre and post self-confidence scores and for each individual item. 

Results:  Two hundred thirty (230) completed questionnaires were included in the analysis.  The mean total self-confidence score pre-test was 31.62 (sd=5.45), which increased significantly posttest to a mean of 39.48(sd=7.94), (t = -14.40, df = 231, p < .01).  Significant changes were found on every item in the questionnaire.  The overall effect size also shows a large impact (d= -1.1).  In looking at individual items, students were mostly low on their self-confidence in assessing patients’ history pre-encounter (items 1,2, 3 & 4), but the significant increase in these scores from a mean of 11 to 15 (disagree to neutral), has the highest average effect size (d= -1.4).  Items 5 to 9 dealt with students’ confidence in interacting with patients using therapeutic communication techniques and seeing patients holistically. Overall, students’ confidence in their ability to therapeutically interact with patients (items 5 to 9) was higher pre-encounter with a range of 3.48, neutral to agree.  These items rose significantly but the average effect size, although large, is lower than the effect size of the changes in items 1 to 4 (d=-.99).

Conclusion: Students’ reported self-confidence in patient communication significantly increased after standardized patient exposures.  The SP encounter showed a large impact in increasing students’ self-confidence.  SP simulations have a positive impact in preparing students for patient encounters in the clinical area.  As students’ self-confidence grow, they are more likely to increase their clinical competence in interacting with patients, especially in psychiatric mental health setting.  Research limitiations and future research directions will be discussed.