The research study was undertaken by Gale Robinson-Smith, Patricia K. Bradley, and Colleen Meakim, of Villanova University College of Nursing. The authors’ contribution to the paper stems from several years of experience in the nursing profession, hence, the information contained in the paper is credible for use as an academic source. The credibility of the paper is furthered by the authors’ reference to peer-reviewed articles. The paper is published in a nursing journal, Clinical Simulation in Nursing, and is therefore aimed at the nursing community, both novices and professionals.
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Research Problem, Variables, & Concepts
The objective of this research was to develop a framework that could simplify the process of assessing psychiatric patients. Previous methods of assessing psychiatric patients have been difficult because student expectation of the interaction with persons who have psychiatric problems is normally filled with anxiety and uncertainty. Therefore, the study makes use us standardized patients (SPs) to prepare students for their interaction with actual patients. SPs are individuals who have been coached to simulate, in a precise and regular manner, patients with medical conditions, in this study, the SPs have been trained to simulate patients with psychiatric conditions.
SPs are independent variables, student response and experience during the study is dependent as it varies among the students, while the significant intervening variables are the different perceptions and expectations of the students before their interaction with the SPs.
Importance to Nursing Profession
This study is very important to the nursing practice since it prepares students for the actual nursing practice and enables them to have some knowledge of what to expect during their interaction with psychiatric patients.
In this paper, the authors use adult development theory and problem-based development as a theoretical structure to assess student satisfaction, confidence, and vital thinking after taking part in a psychiatric nursing replication with a standardized patient (SP). At the end of the study, a nursing student is expected to have the ability to carry out psychiatric nursing evaluation, for example, suicide risk and sanity levels.
The authors do not give any research questions, however, from the description of the research framework, we can deduce that the aim of the study is to assess student confidence and interactions with SPs. Besides, the study teaches and evaluates the students’ use of effective communication skills towards their participation in the nursing practice. Possible research questions include: what is the student response towards SP scenarios? What are students’ expectations towards an interaction with psychiatric patients before and after their exposure to SPs? Can student interaction with patients with psychiatric conditions be improved through exposure to SPs?
The study used 112 young undergraduate nursing students, the paper does not give the criteria used to select the sample. Had they given the criteria, an evaluation of the neutrality or biasness of the method would have been possible. To get the students ready for the interview with SPs, they were required to use textbooks and other literature to enable them come up with questions that might elicit discussion, such discussions create a friendly atmosphere and eases the tension between student and patient in actual nursing practice (Robinson-Smith et al, 2009).
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SPs were recruited from the university’s Communication Department and their training designed by a faculty member from the department. The training involved reviewing particular psychiatric conditions, simulating patient conditions, and how to present nursing students with useful verbal and written feedback on the psychiatric condition being simulated. Since this exercise was mainly designed to train students, the training of SPs was not elaborate. After having a theoretical perspective of the psychiatric nursing theory, students participated in practical SP interviews using the questionnaire designed earlier.
Ethical issues arising from the study include enactment of psychiatric condition by the SPs as this could be a mockery or lack or respects for those genuine patients. To handle these issues, SPs were trained adequately on the psychiatric conditions and the clinical expectations of the nursing students, and their role in making the project a success. Therefore, ethical issues were handled by the training team.
Design and Data Collection
Formative evaluation was used for the simulation procedure, this type of evaluation provides feedback to students through oral and written information relating to clinical performance. The main mode of data collecting was through student interviewing of the SPs. Since the exercise was meant to be a learning exercise, the author’s did not design any system to evaluate the students’ performance, instead, the students were given written and oral feedback through a yes-no answer based on whether they had achieved the desired goals of the study. Student satisfaction and self-confidence were assessed using a process from the National League of Nursing. The 112 students were not divided into samples as the authors were only interested in assessing the use of SP scenarios.
Students experience in SP scenarios were evaluated using a Student Satisfaction Survey tool. Satisfaction with this method of teaching was evaluated using 5 items, with a maximum score of 25 for Satisfaction with Learning, a maximum score of 15 for Self Confidence in the procedure (3 items), and a maximum score of 5 on the Effect of SP interview on critical thinking.
Means of the three parameters used in the survey were calculated and are presented below:
|Parameter||Mean (out of 5)|
|Satisfaction with this method of Learning||4.60|
|Self Confidence in the procedure||4.28|
|Effect of SP interview on critical thinking||4.56|
Table 1: Student Satisfaction Survey results (Sample, N, =112).
For most parts of the SP interview exercise, students’ levels of agreement with the experience were very high. For instance, in the category of Satisfaction with Learning through Standardized Patients, students’ highly agreed with three out five questions on their satisfaction with the exercise. The question that received the lowest rating under the self-confidence category was “The use of standardized patient care scenario will prepare me for exams” (Robinson-Smith et al, 2009).
At the end of the questionnaire, students were asked to give their overall experience of the SP interaction, again, the students indicated their positivity about the procedure, this section also showed the students’ anxiety prior to meeting the SPs for the interview, and the relation of these emotions to the responses given under the three categories. In summary, students were satisfied with the SP experience and mentioned that SP situations gave them an opportunity to practice and improve their communication skills, besides helping them design evaluation questions. The university faculty said that the exercise improved students’ confidence and reduced nervousness and uncertainty towards the interviewing of actual patients with psychiatric conditions.
Data obtained from students’ experience with SPs indicates that the whole experience was successful. These results show that SP encounters enhance the general self-confidence of the learners and improved their critical thinking.
Implications to the Nursing Practice
The use of SP in this study has given students a chance to practice and improve their communication skills, besides helping them design evaluation questions. The study offered a better understanding of simulation procedure and how it can be used in other investigations in the nursing practice. Save for a few modifications, the study was successful and the researcher’s aims were achieved. The findings from the study can assist in training of students to prepare them for the nursing practice. Besides, curriculum and books used during training can incorporate the use of SPs to prepare students adequately.
Personal Evaluation of the Study
Despite these positive ratings, some aspects of the study could be altered to improve the outcome. First, Robinson-Smith et al did not define any research questions, the research question should be the first step in a scientific research since it guides the investigator in undertaking both quantitative and qualitative research. The research question also indicates what the investigator desires to uncover.
Conclusions from the study were based on the means of the three student satisfaction surveys from a sample of 112 students. This lone measure was not sufficient for the study, other statistical measures of spread and centrality such as standard deviation, variance, covariance and correlation values could have improved the accuracy of the findings. Besides, these measures would indicate outliers in the data and hence would be eliminated. Increasing the size of the sample would also give better results, drawing this sample from a wider geographical area would also increase the statistical reliability and replicability of the results.
Another weakness of this study is its failure to use a control population since all 112 students used an SP. Besides, the authors did not conduct any constancy tests to test the uniformity of all SPs, non-uniformity of SPs could easily have affected their responses and hence the findings. The SPs were trained by different personnel from the university’s Communication Department, a factor that could have led to non-uniformity of responses. Such anomalies could have been corrected by using the statistical measures mentioned above.
Future studies into the use of SPs for psychiatry studies should use a larger sample size and use more statistical measures.
Robinson-Smith, G., Bradley P. K., and Meakim C. Evaluating the Use of StandardizedPatients in Undergraduate Psychiatric Nursing Experiences. Clinical Simulation in Nursing, 5(6), e203-211.
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