Abstract:

This paper describes the design of simulated patient (SP) training for health assessment in a high-fidelity nursing simulation. As the conceptual framework for training, constructivism aims to provide a context for the learners in order to teach them concepts of wholes. SP is an individual trained to act as a real patient for simulating a set of symptoms and emotional expression. SP training is essential for improving the imitation fidelity in simulation and validation in health assessment.

Trainers are the senior teachers qualified for SP training. Ten voluntary trainees are recruited from senior Baccalaureate nursing students who completed the course learning of health assessment and medical-surgical nursing.

The first stage is general orientation and knowledge education (six hours). The trainers familiarized the trainees with the scenarios, explained the roles and principles of SP. The symptoms and signs, treatment and prognosis of the disease are taught. The second stage is simulation training (twelve hours). The simulated scenarios are developed using the high-fidelity simulator which is a computer-controlled human patient simulator (SimMan). The trainees clarified the patient’s personality and discussed how to portray the patient condition by means of body language or gestures or verbal responses. The trainers provide the nuances that will make the patient come to life and take the SPs’ perceptions and ideas and incorporate them into the training materials . All the performances followed the script. Any complain should be expressed by language, facial expression, emotion and posture. As each SP role-plays the case, the other SPs observe and comment on the performance. The SPs and trainers fill the checklist as their observation, then all of them review the checklist again for clarifying any of the checklist items. The third stage is the training for a SP as an evaluator in candidate’s performance (two hours). The candidate performance evaluation form is developed in terms of symptom assessment, physical examination, history inquires and communication. It is the observational measurement with two levels (1 Correct, 0 Incorrect / Omitted). The SP should fully understand each items and scoring criteria and concern about candidates' behavior, make the fair and objective assessment. It is essential that the SPs’ performance remain at a high level, and their checklist accuracy is at 85% or higher. Each stage was videotaped in order to provide detailed feedback to the trainees.

Moreover, the SP evaluation form is developed in terms of disease knowledge, role performance, imitation fidelity and communication. It is the observational measurement with three levels (2 acceptable, 1 need to be improved, 0 unacceptable) by two trainers. The inter-rater reliability for each evaluation form is established for minimizing the possibility that the scores would vary from rater to rater.

In summary, students as SPs would have first-hand knowledge and experience within the simulated scenarios. They are likely to be more reliable, and may tolerate more students than real patients. The high-fidelity simulation can be used in SP training. The simulated patients are case specific and are able to assess health assessment skill in a limited area only. Multiple SP encounters need to be designed for more comprehensive clinical skills training or testing in Baccalaureate nursing education.
(Research Project: Macao Polytechnic Institute RP/ESS-06/2017) .

Keywords:

Simulated patient, High-fidelity simulation, Nursing, health assessment, Baccalaureate.