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This study examined the effectiveness of using standardized patients to teach therapeutic communication skills to 89 senior nursing students enrolled in a psychiatric nursing course. Students participated in two interventions with standardized patients - an early formative evaluation and a later summative evaluation. Faculty provided feedback to students. Significant improvements were found in 12 of 14 criteria evaluating students' therapeutic communication skills, suggesting standardized patients are an effective method for teaching these important skills to undergraduate psychiatric nursing students.
This study examined the effectiveness of using standardized patients to teach therapeutic communication skills to 89 senior nursing students enrolled in a psychiatric nursing course. Students participated in two interventions with standardized patients - an early formative evaluation and a later summative evaluation. Faculty provided feedback to students. Significant improvements were found in 12 of 14 criteria evaluating students' therapeutic communication skills, suggesting standardized patients are an effective method for teaching these important skills to undergraduate psychiatric nursing students.
This study examined the effectiveness of using standardized patients to teach therapeutic communication skills to 89 senior nursing students enrolled in a psychiatric nursing course. Students participated in two interventions with standardized patients - an early formative evaluation and a later summative evaluation. Faculty provided feedback to students. Significant improvements were found in 12 of 14 criteria evaluating students' therapeutic communication skills, suggesting standardized patients are an effective method for teaching these important skills to undergraduate psychiatric nursing students.
Communication in Psychiatric Nursing Debra Webster, EdD, RNBC, CNE* Associate Professor and Associate Chair, Salisbury University, 1101 Camden Avenue, Salisbury, MD 21801 USA KEYWORDS Abstract standardized patients; Background: There is limited research into the effectiveness of standardized patient teaching effectiveness; experiences (SPEs) to teach therapeutic communication skills in undergraduate psychiatric psychiatric mental nursing students. Method: A quasi-experimental, one-group, preepost evaluation design was health simulation; used to examine the effectiveness of the use of SPEs to teach therapeutic communication therapeutic skills in psychiatric nursing. Study participants included 89 senior nursing students enrolled communication; in a psychiatric nursing clinical course in a baccalaureate nursing program. communication skills; Results: Faculty provided formative evaluation on 14 criteria and group feedback early in the nursing students; semester for students’ first interaction with a standardized patient (SP). During a second quasi-experimental intervention at the end of the semester, with an SP, summative feedback was used to research; evaluate the student using the same 14 criteria. Significant differences were noted in 12 of training the 14 criteria demonstrating improvement in therapeutic communication skills. Conclusion: Although further research is needed, this study suggests that the use of SPEs is an effec-tive methodology for promoting therapeutic communication skills in undergraduate psychiatric nursing students.
Cite this article:
Webster, D. (2014, February). Using standardized patients to teach therapeutic communication in psy-chiatric nursing. Clinical Simulation in Nursing, 10(2), e81-e86. http://dx.doi.org/10.1016/ j.ecns.2013.08.005. 2014 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved. Effective communication skills are a core competency an increase in the severity of the illness of hospitalized indi- for nurses. Without this essential skill, psychiatric nurses viduals. In addition, a patient may refuse, be considered too are unable to build a therapeutic relationship and care for dangerous or fragile, or refuse to work with a student. This individuals with mental illness. Providing students with may result in encounters with only certain patient diagnoses opportunities to practice therapeutic communication with and no opportunity to interact with patients with common individuals with mental illness can often be a challenge for psychiatric diagnoses. Nurse educators are therefore nurse educators (Webster, 2010). Opportunities may be challenged to substitute other clinical teaching strategies that limited due to decreased patient census, length of stay, and promote the use of therapeutic communication skills. Simulation involving standardized patients (SPs) may be an effective alternative method for teaching therapeutic * Corresponding author: dawebster@salisbury.edu (D. Webster). communication skills in psychiatric nursing. 1876-1399/$ - see front matter 2014 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ecns.2013.08.005 Standardized Patients and Therapeutic Communication e82 education. This includes the interpersonal process recording In addition to providing clinical activities when there in which faculty provide feedback based on student may be limited clinical options, SP experiences (SPEs) documentation of verbal communication, nonverbal behavior, allow faculty to control the types of patient interactions and environmental influences from por-tions of interaction (Founds, Zewe, & Scheuer, 2011; Parsh, 2010). This is of with the patient (Varcarolis & Halter, 2010). This may not be great benefit, because providing a quality psychiatric the best method for teaching and evaluating therapeutic nursing experience can be communication skills. Although the interpersonal process further complicated by fac- recording allows the student to tors such as patient confiden- tiality, aggression, and unpredictability (Hermanns, Lilly, & Crawley, 2011). The use of SPEs allows fac-ulty to align clinical and di-dactic teaching giving students an opportunity to engage with a variety of patient diagnoses, including those with issues of aggres-sion and unpredictability. Students are therefore able to practice in a safe yet controlled environment.
Although SPs have been
utilized to teach commu-nication in the field of medicine for many years, their use in undergraduate nursing is still in its infancy. With limited information re-garding the effectiveness of SPEs as a teaching strategy in undergraduate nursing education, it is imperative
that nurse educators conduct research into this teaching
strategy that is quickly gaining momentum.
Literature Review
Strategies to Teach Communication
The nurseepatient relationship is at the foundation of
providing care to individuals with mental illness. The ability to engage in therapeutic communication is crucial to building this relationship. With scant literature to provide guidance into how to best teach therapeutic communication skills (Webster, Seldomridge, & Rockelli, 2012), faculty often use methods similar to how they were taught during their own nursing Role play was found to have a positive effect when the identify the type of communication technique utilized, it communication of students receiving only didactic educa- may not be accurate and is subject to distortion, because the tion was compared with students who engaged in role play student must rely on memory to document what was said after didactic education (Kesten, 2011). Experiential ap- and to identify nonverbal behaviors (Varcarolis & Halter, proaches including case studies and SPEs designed to 2010). Students may also document how they should have mimic reality offer students ‘‘real-world’’elike experiences responded instead of what they actually said, leading to (Webster et al., 2012) provide other opportunities to learn many missed teachingelearning opportunities. Because therapeutic communication skills. Using a case study com- faculty do not have the opportunity to directly observe an bined with an SP, students practiced communication in a entire studentepatient interaction in the psychi-atric setting, pi-lot activity designed to facilitate communication with students are evaluated on brief observations and written and care for individuals with posttraumatic stress disorder assignments, including the interpersonal pro-cess (Webster et al., 2012). Students commented that they were recording, both of which provide just a snapshot of the better prepared to care for individuals with posttrau-matic student’s ability to use therapeutic communication skills. stress disorder as a result of participating with SPs. Using carefully designed SPEs, faculty are able to control the Although the field of medicine has utilized SPs for many type, complexity, and length of the interaction, which can years, nursing is in the early stages of utilizing SPs to teach also be used to decrease the randomness of patient a variety of nursing skills. It has been suggested that encounters in the clinical setting (Becker, Rose, Berg, Park, simulation using SPs can be an effective method of & Shatzer, 2006). Although high-fidelity simulations are teaching students therapeutic communication skills (Lang often used to allow students to practice technical skills, the & Hahn, 2013). Marken, Zimmerman, Kennedy, use of SPs adds to the authenticity of the experience Schremmer, and Smith (2010) had interdisciplinary teams (Keltner, Grant, & McLeron, 2011) and may promote ther- consisting of pharmacy, medical, and nursing students apeutic communication skills and empathy development. engage with SPs to practice communication skills on the In addition to self-evaluation, peer review has been used difficult topics of child health issues, intimate partner to help students improve communication skills (Yoo & violence, and suicidal ideation. The authors concluded that Chae, 2011). In this study, students in an experimental students gained confidence and improved communica-tion group watched each other’s videos and provided feedback; skills as a result of practicing with SPs in a simulated those in the control group completed only self-evaluation. environment. pp e81-e86 Clinical Simulation in Nursing Volume 10 Issue 2 Standardized Patients and Therapeutic Communication e83 The researchers reported students who participated in peer Sample review had significantly better communication skills and higher learning motivation than students who did not A convenience sample of 89 senior baccalaureate nursing partic-ipate in peer evaluation (Yoo & Chae, 2009). students enrolled in a psychiatric clinical course Debriefing in groups as a form of peer review can be voluntarily participated in the study. Participants ranged in utilized to facilitate discussion including strengths and age from 20 to 60. The sample was made up of 78 (87.6%) weaknesses allowing students to learn from one another. Caucasian, 5 (5.6%) African-American, and 6 (6.7%) other This helps to better prepare students for interactions with students. There were 81 (91%) female and 8 (9%) male real patients and can also decrease the anxiety of working participants in the group (8). Second degree students with this challenging population. Individual and faculty-led comprised 27% and traditional students 73% of the sample. group debriefing can also be used to reinforce application and provide further teaching of theory. When combined Procedure with debriefing and reflection, the use of SPs to teach therapeutic communication provides an active learning Students were voluntarily recruited from those enrolled in the environment in which knowledge and skills are translated psychiatric nursing clinical course taught in the fall of each into practice (Marken et al., 2010). academic year. Permission to conduct the research study was Although there are many advantages to using SPEs, granted by the university’s Human Subjects Research evaluation of effectiveness as a teaching method is needed Committee. A disclosure statement was provided, informing (Keltner et al., 2011). It has been suggested that SPEs participants of the purpose of the study and informed consent create an active learning environment in which students are was obtained. In addition, all participants including SPs gave able to make mistakes and refine skills based on feed-back permission to be video-recorded for subsequent review and (Crider & McNiesh, 2011). Simulation has been shown to critique by faculty and peers. Participants were able to be an effective alternative to traditional clinical withdraw from the study at any time. placements, allowing students to practice skills and experi- ence situations similar to those experienced in actual The Standardized Patient Experience clinical practice (Schlairet & Pollock, 2010). Student self- assessment (Becker et al., 2006) and peer review (Yoo & Ten paid SPs ranging from age 20 to 75 were recruited. Chae, 2011) help students to learn therapeutic communica- They included members of a local acting group, students tion and allow the refinement of student decision-making from theater and communication arts majors, and retired and problem-solving skills in a controlled, safe, and nurses. Scripts were written and training conducted by two nonthreatening environment (Keltner et al., 2011). Debrief- expert psychiatric nursing faculty each with more than 20 ing after SPEs has been noted as an essential component of years of clinical psychiatric nursing experience. Four learning and should be used by faculty to provide sessions each lasting 4 hours were conducted over a period formative feedback to help students understand and apply of 2 months, allowing ample time for SPs to view movies theory to practice (Billings & Halstead, 2009). Last, SPEs and memorize scripts. Didactic content on mental illness, can be de-signed to present a patient problem in a clinically symptoms, and presentation was taught during session one. relevant and realistic way (Becker et al., 2006), allowing Detailed scripts with information about the case, common faculty to target teaching and more accurately evaluate a symptoms, and questions SPs could expect from students student’s communication skills. Similar interactions and along with suggested responses were provided. The SPs patient pre-sentation allows for standardization and greater were given permission to improvise as long as they objectivity in the student evaluation process. maintained character and symptoms. Movies in which professional actors accurately portrayed mental illness were assigned for viewing and faculty-led discussions were Study Purpose held in session two to discuss the movies. During sessions two and three, faculty assumed the student role and SPs The purpose of this study was to determine the effective- practiced the scripts. The SPs were asked to self-reflect on ness of SPEs as a teaching modality to improve nursing their own performance and to provide feedback to other students’ use of therapeutic communication skills with SPs. Faculty also provided feedback to assist SPs in individuals with mental illness. perfecting the performance. Session four was utilized to video-record and critique SP performance. Method Each student participated in two SPEs, one at the beginning of the semester and one at the end of the This study used a quasi-experimental, one-group, preepost semester. During each SPE, they interacted with an SP who evaluation using a 14-point checklist of criteria designed to had been trained to portray an individual with one of the examine the effectiveness of the use of SPEs to teach following diagnoses: Paranoid schizophrenia, bipolar therapeutic communication skills in psychiatric nursing. mania, depression with suicidal ideation, obsessive pp e81-e86 Clinical Simulation in Nursing Volume 10 Issue 2 Standardized Patients and Therapeutic Communication e84
Evaluation First SPE (mean) Second SPE (mean) t p Approaches client using a nonthreatening body stance 1.45 1.27 1.237 .218 Introduces self 1.31 1.27 0.328 .743 * Establishes eye contact, if appropriate 1.66 1.22 1.978 .049 * Engages in efforts to put the patient at ease 2.06 1.42 2.978 .003 * Maintains appropriate therapeutic boundaries 2.61 1.40 3.631 <.001 * Assesses for safety 3.20 1.71 5.010 <.001 * Responds appropriately, verbally and nonverbally to patient’s 2.49 1.78 2.930 .004 verbal statements * Responds appropriately to patient’s nonverbal behavior 2.82 1.58 4.898 <.001 * Uses therapeutic communication techniques 2.01 1.57 2.610 .010 * Sets limits on inappropriate behaviors 3.34 2.07 5.058 <.001 * Validates meaning of patient’s response 2.85 1.63 3.749 <.001 * Demonstrates anxious behaviors 3.26 4.46 1.969 .050 * Summarizes content of interaction 2.93 1.82 4.627 <.001 * Terminates interaction appropriately 2.26 1.63 2.491 .014 * p < .05. compulsive disorder, borderline personality disorder, de- Faculty Feedback mentia, or posttraumatic stress disorder. The 15- to 20- minute sessions were video-recorded for later review by Feedback from faculty consisted of a 14-point checklist of students and faculty. The SPs randomly selected which criteria (Table 1). This criteria was rated on a 5-point Likert case to portray. Students did not receive any information scale of 1 (strongly agree) to 5 (strongly disagree) for each about the SPE before the event. Instead, they were only criteria with the exception of demonstration of anxiety which told that they would be interacting with an SP and that they was rated on a reverse scale of 5 (strongly agree) to 1 would receive feedback from faculty on 14 expectations (strongly disagree). Review of the video-recording dur-ing that were provided before the interaction. small group debriefing by faculty and students also pro-vided A multifaceted approach to student feedback and evalu- opportunity for peer review and further teaching of ation was provided. The first SPE early in the semester was therapeutic communication skills with a discussion of the utilized for formative feedback from faculty to assist the challenges of working with this patient population, as well as students in developing therapeutic communication skills, and reinforcement of theory and clinical application. the second SPE late in the semester was utilized for To maintain objectivity, faculty were trained on how to summative feedback in which the student’s use of therapeu-tic properly use the evaluation tool to evaluate student perfor- communication skills was graded. Students watched their mance for each of the 14 identified areas. For example, video and conducted a self-reflection of strengths and areas when students introduced themselves, it was an expectation for improvement. Students also identified the communica-tion that they gave their name, stated that they were a nursing techniques utilized as well as a diagnostic evaluation of the student, and informed the patient how much time they patient with supporting assessment data. would spend with them during the session. In addition to debriefing, review of video clips by groups of six to eight students was conducted by faculty to further teach communication concepts using a problem- Results based learning approach. Many students identified nonverbal behaviors that could lead to problems in Data were analyzed using SPSS version 20 (SPSS, Inc., establishing a therapeutic nurseepatient relationship during Chicago, IL). Mean scores were computed for each the first SPE, allowing them to make improvements during evaluation criteria and the faculty evaluation scores for the their second SPE. Students also developed an awareness of first and second SPE were compared using a t-test for the SPs’ nonverbal behaviors and were more alert to safety independent samples. Significant differences were noted in concerns during the second SPE. Students commented on 12 of the 14 evaluation criteria (Table 1). decreased anxiety and increased confidence during their Although students did not demonstrate significant second SPE. Students also noted improvements, including improvement on 2 of the 14 evaluation criteriadapproaching the use of therapeutic communication techniques, client with a nonthreatening body stance and introducing congruency in ver-bal communication and nonverbal selfdthere was improvement noted for the two. Because the behavior, providing patient teaching, and summarizing the means scores indicated that students performed well on these content of the interaction during their second SPE. two evaluation criteria during the initial SPE (mean, 1.45 pp e81-e86 Clinical Simulation in Nursing Volume 10 Issue 2 Standardized Patients and Therapeutic Communication e85 approaching client; mean, 1.31 introducing self), there was experience and described an overall decrease in anxiety little room for improvement during the second SPE (mean, during interactions with individuals with mental illness. Many 1.27 approaching client; mean, 1.27 introducing self). students commented they appreciated the opportunity to gain Although student anxiety is expected to be high initially, experience communicating with a patient with a diagnosis that anxiety should decrease with repeated contact and they did not get the chance to interact with in the inpatient increased confidence in working with the mentally ill psychiatric setting. Students also acknowledged that they population. Student anxiety was 3.26 for the initial SPE found practicing communication with a more difficult patient and 4.46 on a scale of 5 (strongly agree) to 1 (strongly in the simulated environment gave them the confidence they disagree), indicating an overall decrease in student anxiety. needed to engage with ‘‘real patients.’’ In addition to decreased anxiety, students demonstrated Faculty satisfaction with the standardized presentation of significant improvement from the first to the second SPE in symptoms and objective method of evaluating the student was all other evaluation criteria. There was improvement noted reported. Faculty also commented on the importance of group in students’ ability to establish eye contact (mean, 1.66 debriefing and found that although many students did not initial; mean, 1.22, second SPE), suggesting increased want other students to see their video-recording, peer review student comfort and confidence. There was also improve- was a very important component of student learning and, ment in the students’ ability to engage in efforts to put the when carefully led by faculty, provided a means for students patient at ease (mean, 2.06 initial; mean, 1.42 second SPE), to provide and receive peer feedback in a profes-sional suggesting a move away from focus on self and toward the setting. Self-reflection was also noted to be an important focus on the patient’s needs. component of student learning. Patient safety is important in psychiatric nursing. As Research using SPEs to teach therapeutic communica- such, safety assessments and the ability to set limits on tion in undergraduate psychiatric nursing is very limited. inappropriate behavior become paramount. Improvements The findings from this study support the use of SPEs to were noted for both of these competencies (safety assess- teach and evaluate therapeutic communication skills in ment: mean, 3.2 initial and 1.71 second SPE; and limit undergraduate nursing education. Future directions for this setting: mean, 2.85 initial and 1.63 second SPE). project include an examination of interrater reliability of In building a therapeutic relationship, focus on the SP and faculty feedback for high-stakes testing, providing patient and a genuine display of empathy must be present written feedback from SPs to students, and including the (Varcarolis & Halter, 2010). The student should be able to SPs in debriefing sessions with students and faculty. respond appropriately to the patient’s nonverbal behavior Comparison and control groups will also be utilized to and verbal statements using therapeutic communication provide further insight into the effectiveness of the use of techniques. Improvements were also noted in all three of SPs to teach and evaluate therapeutic communication. Pre- these areas (using therapeutic communication techniques: and post-testing student knowledge of therapeutic commu- mean, 2.01 initial and 1.57 second SPE; responding appro- nication skills is another option for further exploration of priately to verbal statements: mean, 2.49 initial and 1.78 the effectiveness of this teaching strategy. sec-ond SPE; and responding appropriately to nonverbal behavior: mean, 2.82 initial and 1.58 second SPE). The ability to validate the meaning of a patient’s Limitations response is also important when working with individuals with mental illness. This may help to further build the In this study, one limitation related to the small sample relationship and establish understanding and empathy. size. In addition, participants were not randomly selected, Improvement was also noted for this skill (mean, 2.85 but were a convenience sample. There was no comparison initial and 1.63 second SPE). using control and comparison groups. Although all students Last, the appropriate termination of the session should were provided didactic course content in the same manner, include what transpired during the interaction, a summari- it is possible that other confounding variables could have zation of patient concerns, and plans for the next course of been responsible for some of the noted improvements. For action, including teaching and follow-up care. Improvements example, some students may have been influenced by were also noted for these two areas (summarizing content of personal experience or prior course work in psychology. In interaction: mean 2.93 initial and 1.82 second SPE; termi- addition, clinical experiences with mentally ill patients in nating appropriately: mean 2.26 initial and 1.63 second SPE). the outpatient and inpatient acute settings between the first and second SPE may have led to some of the noted improvement in therapeutic communication skills. It is also Discussion important to take into consideration that knowledge of the rating scale may have influenced improvements. Additional research is therefore needed to determine all This study found that SPEs can be utilized to teach and assess undergraduate nursing students’ use of therapeutic commu- influencing variables. Furthermore, reliability of the nication skills. Students reported satisfaction with the learning evaluation tool has not yet been established. pp e81-e86 Clinical Simulation in Nursing Volume 10 Issue 2 Standardized Patients and Therapeutic Communication e86 In conclusion, using SPEs as a clinical teaching method Billings, D. M.,, & Halstead, J. A. (2009). Teaching in nursing: A guide for faculty (2nd ed.). St. Louis: Saunders Elsevier. allows a unique way for students to develop communication Crider, M. C., & McNiesh, S. G. (2011). Integrating a professional skills and for faculty to evaluate performance in an objective appren-ticeship model with psychiatric clinical simulation. Journal of manner. This simulation utilized SPEs to teach therapeutic Psycho-social Nursing and Mental Health Services, 49(5), 42-49. http: communication skills in a controlled, safe and nonthreatening //dx.doi.org/10.3928/02793695-20110329-01. learning environment. Debriefing, self-reflection, and peer Founds, S. A., Zewe, G., & Scheuer, L. A. (2011). Development of high review helped students to further enhance therapeutic fidelity simulated clinical experiences for baccalaureate nursing stu- dents. Journal of Professional Nursing, 27, 5-9. http: communication skills. Student and faculty response to this //dx.doi.org/10.1016/j.profnurs.2010.09.002. learning activity was positive. Hermanns, M., Lilly, M. L., & Crawley, B. (2011, March). Using clinical As faculty continue to develop SPEs, additional data simulation to enhance psychiatric nursing training of baccalaureate need to be collected to establish the effectiveness of this students. Clinical Simulation in Nursing, 7(2), e41-e46. http: //dx.doi.org/10.1016/j.ecns.2010.05.001. growing teaching methodology, especially if high-stakes Keltner, N. L., Grant, J. S., & McLeron, D. (2011). Use of actors as stan- testing is utilized. Although much research has been dardized psychiatric patients: Facilitating success in simulation experi- conducted in the field of medicine showing that SPs are an ences. Journal of Psychosocial Nursing, 49(5), 34-40. http: effective way to teach communication and assessment //dx.doi.org/10.3928/02793695-20110329-02. skills, research on the use of SPs to teach therapeutic Kesten, K. S. (2011). Role-play using SBAR technique to improve observed communication skills in senior nursing students. Journal of communication skills in undergraduate nursing is limited. Nursing Education, 50(2), 79-87. http://dx.doi.org/10.3928/01484834- Evaluating the effectiveness of any teaching strategy is a 20101230-02. necessary component in providing quality nursing educa- Lang, C. S., & Hahn, J. A. (2013). Blast model: An innovative approach tion. Continued research and valid evaluation instruments to prepare second-degree accelerated BSN students for inpatient are needed. This will help nurse educators to determine the psychiat-ric clinical experiences. Journal of Psychosocial Nursing, 51(3), 38-45. http://dx.doi.org/10.3928/02793695-20130130-01. best strategies to teach therapeutic communication skills in Marken, P. A., Zimmerman, C., Kennedy, C., Schremmer, R., & Smith, K. undergraduate psychiatric mental health nursing. This may V. (2010). Human simulators and standardized patients to teach also lead to the use of alternative clinical teaching strate- difficult conversations to interprofessional health care teams. gies that are most effective in helping students to apply American Journal of Pharmaceutical Education, 74(7), 120-128. http: theory in practice. As nurse educators seek high-quality //dx.doi.org/10.5688/aj7407120. Parsh, B. (2010). Characteristics of effective simulated clinical experience educational strategies to teach communication, SPEs may instructors: Interviews with undergraduate nursing students. Journal of be one such strategy. Additional research will also help to Nursing Education, 49, 569-572. http://dx.doi.org/10.3928/01484834- provide insight into how to better facilitate the develop- 20100730-04. ment of a therapeutic relationship and improve care for Schlairet, M. C., & Pollock, J. W. (2010). Equivalence testing of individuals with mental illness. The use of well-planned traditional and simulated clinical experiences: Undergraduate nursing students’ knowledge acquisition. Journal of Nursing Education, 49, 43- SPEs by nurse educators can provide alternative clinical 47. http: //dx.doi.org/10.3928/01484834-20090918-08. learning activities to ensure that students have the assess- Varcarolis, E. M., & Halter, M. J. (2010). Foundations of psychiatric mental ment knowledge and communication skills to provide care health nursing: A clinical approach. St. Louis: Saunders Elsevier. that is therapeutic and safe. As such, well-prepared Webster, D. (2010). Promoting empathy through a creative reflective teach-ing psychiatric nurses will enter the profession. strategy: A mixed-method study. Journal of Nursing Education, 49(2), 87- 94. http://dx.doi.org/10.3928/01484834-20090918-09. Webster, D., Seldomridge, L., & Rockelli, L. (2012). Making it real: Using standardized patients to bring case studies to life. Journal of References Psychoso-cial Nursing and Mental Health Services, 50(5), 36-41. http: //dx.doi.org/10.3928/02793695-20120410-06. Becker, K. L., Rose, L. E., Berg, J. B., Park, H., & Shatzer, J. H. (2006). Yoo, M. S., & Chae, S. (2011). Effects of peer review on communication The teaching effectiveness of standardized patients. Journal of Nursing skills and learning among nursing students. Journal of Nursing Educa- Education, 45, 103-111. tion, 50(4), 230-233. http://dx.doi.org/10.3928/01484834-20110131-03. pp e81-e86 Clinical Simulation in Nursing Volume 10 Issue 2
Peer Role-Play and Standardised Patients in Communication Training A Comparative Study On The Student Perspective On Acceptability, Realism, and Perceived Effect
THERACOM: A Systematic Review of The Evidence Base For Interventions To Improve Therapeutic Communications Between Black and Minority Ethnic Populations and Staff in Specialist Mental Health Services