Improving Nursing Students’ Learning: Using the Standardized Patient Method in Patient Education Lesson Volume 1 - Issue 4

Ashrafalsadat Hakim*

• Nursing Care Research Center in Chronic Diseases, Department of Nursing, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Received: February 03, 2020   Published: February 13, 2020

Corresponding author: Ashrafalsadat Hakim, Nursing Care Research Center in Chronic Diseases, Department of Nursing, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

 

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Abstract

Introduction: A standardized patient is a modern educational method that can develop clinical decision making. Educational professionals believe in the field of medicine the use of standardized patient is a way to complete Educational experiences of Medical Group students. Therefore, this study aimed to determine the promotion of nursing students’ learning using the standardized patient method in the patient education lesson.

Methods: The method of Standardized patient for 8 consecutive years (2012-2020) was used for nursing students. In this study, for presentation the lesson of patient education used from the method of Standardized patient for 120 undergraduate nursing students (semesters 3) and 80 discontinuous undergraduate nursing students (semester 2). This way after the organize groups Based on the executable selective topics (Common health problems in the community) by the students done in assigned places and class hours (10 sessions, 2 hours) that was determined by the education department in the School of Nursing and Midwifery. It should be mentioned that the students after the education to do essential practices at different times. As well as the students participated with the written informed consent in educational sessions and workouts the program of Standardized patient. Finally, the total score of students were categorized into 3 groups: score80-100 for full satisfaction of the implementation of the method, score 60-79 for moderate satisfaction, score below 60 for low satisfaction.

Results: The results of Independent t-test showed that between the mean scores of survey form completed by students there is a significant difference between the two groups (p=0.001). Conclusion: Generally, the study findings show that the educational program based on the standardized patient would be effective in the development of clinical decision-making of nursing students.

Keywords: Standardized patient; Education; Learning; Nursing student

Introduction

Standardized patient is one of the new educational methods that can promote clinical decision making. The history of the first Standardized patient returns to 1963. The pioneer of Standardized patient education was Dr. Howard Barrow, a neuroscientist and medical educator at the University of Texas, and Mrs. Rose McVilliam’s first Standardized patient. He played a role in teaching natural neural tests. Over the years, Dr. Barrow has expanded his work on the use of Standardized patient in medical education. His innovation is used in all world-renowned medical schools such as Oxford and Johns Hopkins and so on.

Standardized Patient Definition states: Educated individuals are able to present a clinical problem in a standardized and repeatable manner under similar conditions. On the other hand, the person is trained to correctly represent the history of the disease, individual history, emotional structure, responses, and clinical findings of a real patient. Standardized patients can be used in many professional domains related to performance measurement and skill development. These include: Interviewing skills, Communication skills, Structural skills, Feedback skills, Assessment of clinical personnel by anonymous Standardized patient, A template for producing educational video tapes, a template for Continuing Medical Education conferences. The standardized patient approach is used for theoretical and clinical training including: one standardized patient and one student, small group screening and practice sessions, large group screening, Role Playing, Based on the pivotal problem in Clinical environment. Standardized patients are also used for various educational experiences in medical school colleges. They are considered as the most important source of education for applying practical techniques during lectures. The use of Standardized patients has many benefits including: Available at any time. Available in any set. Provides the possibility of presenting identical and stable competitive. Avoiding the therapeutic errors that occur when using real patients, Provides opportunities for excellence and completion of skills. Provides the possibility of practicing practical skills in difficult situations. Due to the characteristic of the patient education lesson, it is necessary that Implementation of Standardized patient method be considered for nursing students to enter clinical practice. Many studies have been done in this regard, as Assadi states in his review study that in many cases Standardized patient has more value in the learning process of learners than the real patient.

So, the student should be taught in a way that more effective to encounter with the real patient [1]. Zagheri et al. [2] also argue that the use of human patient simulations and mannequins reduces anxiety and facilitates student acquisition of skills, reduces errors, reduces the likelihood of harm to patients and Levels of nursing education can be used [2]. Also, according to the American Institute of Medicine, Health organizations and educational institutions are required to use simulation to educate students to reduce the risk and harm to patients [3]. Nursing colleges in 16 states are currently allowed to replace simulation training in clinical education hours, and another 17 states are expected to receive this in the future [4]. Robinson et al. [5], express in this regard, the use of Standardized patient in clinical skills training improves self-esteem and students’ critical decision-making power [5]. Anderson et al. [6] also argue that educationalists in the medical field believe that using a patient’s perspective is a way to complement the medical experiences of medical students, enabling them to more effectively interact with clinical problems [6]. In this regard, Manzari et al. [7] in their research recommend that educational program Based on standardized patient be considered into in-service continuing education programs to improve nurses’ clinical decision making [7].

Considering the research done on how to implementation of Patient education lesson, Many shortcomings were identified, as revealed in interviews with learners and Surveys from them (students’ feedback) this lesson is theoretical and the student does not actually acquire the necessary skills to teach the patient in the clinical setting. Also reviewing lecturer interviews with students, of course continuously throughout the years of teaching (During the implementation of the standardized patient approach), two very important points came out of their statements: Concerns of relevant learners the lack of clinical competence in the future and the confusion of students in solving educational problems. Also, given the quantitative data collected from the survey form. For example, 90% of students have reflected the lack of knowledge of the correct principles of communication with patients and how to provide a proper education to clients. Therefore, this study was carried out with the aim of promoting the learning of nursing students using standardized patient in the in the lesson of patient education.

Methods

The method of Standardized patient for 8 consecutive years (2012-2020) was used for nursing students of Ahvaz Jundishapur University of Medical Sciences/ Iran. In this cross-sectional descriptive study, for presentation the lesson of patient education used from the method of Standardized patient for 120 undergraduate nursing students (semesters 3) and 80 discontinuous undergraduate nursing students (semester 2). This method was implemented as follows for learners. Students at the beginning of the semester, after explaining and justifying the implementation of the standardized patient method for patient education unit, are divided into groups of two and after organizing groups based on selective topics implemented by the learners mentioned above (common health problems in the community). ) Was held at the School of Nursing and Midwifery and in the classroom designated by the training unit (10 sessions, 2 hours). Of course, in three sessions (before running the program), the students were taught how and when to run the standardized patient program (2 hours). It should be noted that the learners performed the necessary exercises at different hours after Education. Meanwhile, Students also participated in standardized patient education and practice sessions with informed and written consent. It should be noted that the number of Educational sessions depends on the complexity of the patient’s roles and experiences (in most cases 3-5 Educational sessions are sufficient for proper role playing). It was also necessary that all standardized patients attend training courses designed to train them. According to the application’s execution feature, Learners while doing it required feedback should have been given to the presenter in the following Items, for example: Success in fulfilling this role, getting information about the nature of standardized patient, how motivated he is to perform the “ standardized patient “ role, how to acquire communication skills, how to acquire perceptual skills. It should be noted that at the end of each semester students have been surveyed regarding their role playing (standardized patient). Finally, the total score of students were categorized into 3 groups: score 80-100 for full satisfaction of the implementation of the method, score 60-79 for moderate satisfaction and score below 60 for low satisfaction. Descriptive and inferential statistical tests (independent t-test) were used to analyze the collected data.

Results

The results showed that the educational program based on the standardized patient would be effective in the development of clinical decision-making of nursing students. Also With the implementation of this method in educational institutions can be observed the following positive results: Enhance students’ skills in completing, extracting information from hospital records, and acquainting with the records in the file, and greater ability to get the right biography and appropriate communication with the patient for proper education In line with health problems, psychic, social, and so on. Also, appropriate professional encounter with the health team. The results of Independent t-test showed that between the mean scores of survey form completed by students there is a significant difference between the two groups (p=0.001) (Table 1).

Discussion

This study aimed to determine the promotion of nursing students’ learning using the standardized patient method in the patient education lesson. It should be noted that this study (standardized patient method) was conducted for nursing undergraduate students for 8 years and constantly as a course in the semesters. In addition, Necessary evaluation in each period is well done According to learners’ views on how to improve this method, removing bugs, fixing shortcomings and obstacles to its implementation.

Based on the results, educational program based on the standardized patient is effective in developing clinical decision making of nursing students. The results of other studies indicate that simulation method is very effective in practical and communicational skills training, critical thinking and clinical decision making [8]. On the other hand, standardized patient is a key participant in the simulation experience for students and faculty. In this regard, the researchers also say that simulations allow nursing students to develop skills as well as improve critical thinking, problem-solving and decision making, especially when using a standardized patient [9].

Due to the results of this study, there was a significant difference between the mean scores of the survey form completed by the students in the two groups. Which may indicate that with increasing practical skill, Learners’ satisfaction level with themselves and according to it increases from the respective educator. In this regard, the researchers stated that in order to equip medical students with all the necessary skills in dealing with patients to provide optimal treatment, the need to use real patients in educational settings has been highlighted. But all the skills needed cannot be practiced in real patients due to their safety and well-being. Therefore, the use of standard patients or simulated patients as an alternative to real patients demonstrates their importance in simulation-based medical education.

When simulated patients or standardized Patients are used, there would be a control Over the learning content and the presentation, or the clinical scenarios can be repeated many times and are matched to the stage of training of the students [10]. The results of this study showed that 75% of learners were completely satisfied with the implementation of the standardized patient method in teaching patient education lesson.

In this regard, the results of the study by Hashemi et al. [11] showed that 87% of the intervention group described Simulation using the standardized patient as an appropriate teaching method and 85% preferred the standardized patient approach to the lecture method and they have stated that simulation with standardized patient will increase motivation and interest, knowledge, performance and it will eventually lead to more learning in the learners [11].

The results also show that simulation training is more effective in performing pelvic examinations and recording the results than traditional training. Also, simulation training leads to better student learning [12]. It should be acknowledged that these findings are consistent with the results of this study. Thus, it reflects this fact that Learners with practice in applying this method will be able to perform their clinical role well in providing patient and client education. However, according to the statements of nursing students participating in this study, it was found that this method has a great impact on their learning and awareness in providing proper care. In this regard, the results of the researchers’ study also confirm this fact that Injections training method in combination with standardized patient In addition to increasing average learning and reducing anxiety while performing different types of injections, it increases the satisfaction of students in different medical groups [13]. On the other hand, researchers have stated that standardized patients are a unique valuable tool for measuring quality of care [14].

In this regard, Researchers believe that standardized patients are a very reliable educational tool and are used by medical professionals around the world. Also, considering standardized patients’ views on participating in medical education, the benefits of their experiences include: The feeling of participation in health and therapeutic care, increasing collaboration with health care providers and improving health behaviors [15]. So, the aforementioned learning methods have a tremendous impact on providing the right clinical decisions and the actions that follow. Problems with the implementation of this method were to satisfy the learners and instructors of this lesson and to increase their attention to the active participation in the implementation of this method and another lack of proper place to present this method. In line with the above results, it is suggested, Patient education lesson instructors using standardized patient method and practicing this method by students, take more effective steps. Because in the end, implementing this approach in the relevant institutions will improve the quality of nursing care and increase client satisfaction. Also this teaching method in clinical education programs in different fields of medicine (medicine, nursing, midwifery, etc.), considering the specificity of the relevant lesson (including physical exam lesson and similar lessons) during student era that is theoretical and practical in order to improve clinical competence be considered. On the other hand, if the health system emphasizes the implementation of pathogenesis in all medical educational institutions, ultimately, one of the benefits of implementing this approach is the satisfaction of health customers (clients, patients and families).

Conclusion

Given the effectiveness of educational program Based on standardized patient in developing nursing students’ clinical decision making, It can be stated that these educated individuals who are also future graduates will be able manage all clinical cases in a standardized and repeatable manner in similar conditions in health care centers.

On the other hand, this method is also used to evaluate the clinical competence of all medical students in different faculties. In view of this, it is essential that a standardized patient approach be developed to improve the quality of health services in all health education institutions. It is clear that by fulfilling this goal we can see the satisfaction of our clients in health services as well as the cost effectiveness of education, treatment and so on.

Acknowledgment

This article is adapted from the educational process. Also, The Center for Medical Education Development/Ahvaz Jundishapur University of Medical Sciences, Ahvaz/ Iran, also gratefully acknowledges that it would not have been possible without their cooperation.

References

1. RME (2017) Research in Medical Education. 1(1): 47-51.
2. Zaghari tafreshi M, Rasouli M, Sajadi M (2013) Simulation in nursing education: A review article. Iranian Journal of Medical Education 12(11): 888-894.
3. Durham CF, Alden KR (2008) Enhancing patient safety in nursing education through patient simulation. Patient safety and quality: An evidence-based handbook for nurses 6(3): 221-250.
4. Kathleen BG, Marilyn HO (2010) Clinical Teaching Strategies in Nursing. (3^rd) Springer Publishing Company, New York, USA.
5. Robinson Smith G, Bradley PK, Meakim C (2009) Evaluating the use of standardized patients in undergraduate psychiatric nursing experiences. Clin Simul Nurs 5: 203-211.
6. Anderson M, Holmes TL, LeFlore JL, Nelson KL, Jenkins T (2010) Standardized patients in educating student nurses: One school's experience. Clin Simul Nurs 6(2): 61-66.
7. Manzari Z, Shahraki Moghaddam E, Heshmati Nabavi F, Mazloom S R, Khaleghi E (2015) The effects of teaching by using standardized patients on critical care nurses’ clinical decision making. IJCCN 8(2):69-78.
8. Pakpour V, Hasankhani H, Fathi Azar E, Sheikh Alipour Z, Salimi S (2014) Overview of simulation in nursing: A review article. Educational Development of Judishapur 5(3): 281-287.
9. McIntosh CE, Thomas C, Edwards A (2018) A standardized patient and faculty’s viewpoint on working together on an autism spectrum disorder simulation. Journal of Nursing Education and Practice 8(7): 91.
10. Beigzadeh A, Bahmanbijri B, Sharifpoor E, Rahimi M (2016) Standardized patients versus simulated patients in medical education: Are they the same or different. Journal of Emergency Practice and Trauma 2(1): 25-28.
11. Hashemi J, Jamshidian S, Haghani F (2017) comparing the effects of “lecture” and “simulated patient” teaching methods on promoting the knowledge and performance of healthcare providers. Iranian Journal of Medical Education 17: 145-156.
12. Erfanian F, Khadivzadeh T (2008) The effects of Simulation Based and Traditional Education on students’ skill in Pelvic examination. Horizon Med Sci 14 (2): 61-69.
13. Ebrahimi Fakhar HR, Hekmatpou D (2013) Effect of injection teaching by simulated patient on learning and anxiety level of students. Educ Strategy Med Sci 6 (3): 159-164.
14. King JJ, Das J, Kwan A, Daniels B, Powell Jackson T (2019) How to do (or not to do) … using the standardized patient method to measure clinical quality of care in LMIC health facilities. Health policy and planning 34(8): 625-634.
15. Plaksin J, Nicholson J, Kundrod S, Zabar S, Kalet A, et al. (2016) The benefits and risks of being a standardized patient: A narrative review of the literature. The Patient-Patient-Centered Outcomes Research 9(1): 15-25.